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UPJ INSIGHT Surgical Site Infections in Open and Laparoscopic Operations in Rooms with Open-Floor Drainage Systems

By: Adri M. Durant, MD, Mayo Clinic, Phoenix, Arizona; Madeline A. Whitney, BS, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona; Yu-Hui H. Chang, PhD, MS, Division of Clinical Trials and Biostatistics, Mayo Clinic, Scottsdale, Arizona; Michelle A. Larson, DNP, RN, NE-BC, Mayo Clinic, Phoenix, Arizona; Paras H. Shah, MD, Mayo Clinic, Rochester, Minnesota; Timothy D. Lyon, MD, Mayo Clinic, Jacksonville, Florida; Mitchell R. Humphreys, MD, Mayo Clinic, Phoenix, Arizona; David A. Etzioni, MD, MS, Mayo Clinic, Phoenix, Arizona; Mark D. Tyson II, MD, MPH, Mayo Clinic, Phoenix, Arizona | Posted on: 27 Nov 2023

Durant AM, Whitney MA, Chang YH, et al. Surgical site infections in open and laparoscopic operations in rooms with open-floor drainage systems. Urol Pract. 2023;10(6):621-629.

Study Need and Importance

Surgical site infections (SSIs) are common postoperative complications. Some operating rooms have open-floor drainage systems for fluid disposal during endourologic cases, although nonendoscopy cases are not always allowed in these rooms. We hypothesized that operating rooms with open-floor drainage systems would not materially affect risk of SSIs for patients undergoing open and laparoscopic procedures.

What We Found

We identified 8419 surgical cases, of which 802 (9.5%) were performed in operating rooms with open-floor drainage systems; 166 patients (2.0%) had SSIs. Of the SSIs, 7 (4.2%) occurred in operating rooms with open-floor drainage systems. Surgical specialty, American Society of Anesthesiologists physical status, higher case acuity, dyspnea, immunosuppression, longer surgical duration, and wound classification were associated with SSIs (P < .05 for all). The odds ratio of SSIs for urologic cases performed in a room with vs without open-floor drainage systems was 1.30 (P = .65; Figure).

Figure. Adjusted odds ratio for surgical site infections (SSIs) in urologic cases by clinical and operative variables. The dotted line denotes no association. ASA indicates American Society of Anesthesiologists; BMI, body mass index; OR, operating room.


This is a retrospective, single-institution study, which limits the generalizability of the data as each institution may vary in infection prevention measures impacting SSI rates such as antibiotic prophylaxis implemented or closure techniques.

Interpretation for Patient Care

This study provides preliminary evidence that operating rooms with open-floor drainage systems do not appear to increase postoperative risk of SSI, a finding that contradicts current building codes that regulate against open-floor drainage systems in operating rooms.