Effect of Subcutaneous Negative Suction Drain on Surgical Site Infection Following Colorectal Surgery: A Systematic Review and Meta-Analysis

Abstract

Background Surgical site infections (SSIs) are among the most common complications following colorectal surgery. This study aimed to systematically review existing evidence on the outcomes of subcutaneous negative suction drain versus no drain in adults undergoing colorectal surgeries.

Methods A systematic review and meta-analysis was conducted to compare the SSI rates between subcutaneous negative suction drain and the no-drain in adults (18 years or older) undergoing colorectal surgery. Randomized controlled trials (RCTs), prospective, or retrospective studies till 2025 reporting use of subcutaneous negative suction drain in elective and emergency colorectal surgeries were included. SSI was defined based on Center for Disease Control and Prevention (CDC) criteria. Results were expressed as Relative Risk (RR) and Confidence interval (CI) of 95%. A p value < 0.05 was considered statistically significant.

Results Combined data from 2177 patients across 10 studies (four: RCTs, five: retrospective cohort, and one: prospective cohort) showed a significant reduction in overall SSIs by 60% (RR = 0.40; 95% CI, 0.30–0.53; p < 0.0001) in groups with a subcutaneous negative suction drain compared to those without. There was a significant reduction in superficial SSIs by 58% (RR = 0.42; 95% CI, 0.26–0.66; p = 0.0002). There was no significant reduction in deep SSIs and organ-space SSIs. The included studies were of medium to high quality.

Conclusions Subcutaneous negative suction drains reduce overall and superficial SSI after colorectal surgery, but do not affect deep or organ-space infection.

Originality Statement This paper provides updated evidence demonstrating that subcutaneous negative suction drains significantly reduce overall and superficial surgical site infections after colorectal surgery, and acknowledges their limited effect on deep and organ-space infections, supporting selective use.

Trial Registration: The study protocol was registered with PROSPERO international prospective register of systematic Reviews (Registration ID: CRD420251012636)