Surgical drain placement in distal pancreatectomy is associated with an increased incidence of postoperative pancreatic fistula and higher readmission rates

Christopher W Mangieri, Michael Kuncewitch, Brett Fowler, Richard A Erali, Omeed Moaven, Perry Shen, Clancy J Clark, Christopher W Mangieri, Michael Kuncewitch, Brett Fowler, Richard A Erali, Omeed Moaven, Perry Shen, Clancy J Clark

Abstract

Background: Postoperative pancreatic fistula (POPF) can result in significant morbidity after distal pancreatectomy (DP). It is common practice to place prophylactic surgical drains during DP to monitor and minimize POPF complications; however, their use is controversial.

Objective: The aim of this study is to determine if drainage helps to prevent adverse outcomes and decrease the need for additional interventions after DP.

Methods: All patients who underwent DP without vascular resection were identified in the 2014 Targeted Pancreatectomy American College of Surgeons National Surgery Quality Improvement Program Participant Use File. Patients undergoing emergency procedures, American Society of Anesthesiology (ASA) 5, or diagnosed with preoperative sepsis were excluded. Univariate and multiple variable analyses were performed to evaluate postoperative outcomes based on use of surgical drain.

Results: A total of 1158 patients (age median: 62; interquartile range: 16; female 58.6%) underwent elective DP with 85.1% (n = 985) having drain placed at time of operation. Laparoscopic technique was used in the majority of patients (54.1%, n = 619). POPF occurred in 201 patients (17.5%). Additional percutaneous drain was required in 106 patients (9.2%). POPF was higher in surgical drain group, 19.4% vs 6.9% (P < .001). Need for percutaneous drain was similar between drain and no drain groups, 9.3% vs 8.1% (P = .600). Postoperative sepsis, shock, major complication, reoperation, and 30-day mortality was similar between drain and no drain groups (all P > .05). However, readmission was higher in the surgical drain group, 17.8% vs 10.4% (odds ratio [OR]: 1.9; 95% confidence interval [CI]: 1.1-3.1; P = .018). After adjusting for age, ASA, and operative time, readmission remained higher in the surgical drain group (OR: 1.9; 95% CI: 1.1-3.2; P = .016).

Conclusion: The use of surgical drainage during DP was associated with increased incidence of readmission and POPF. Drainage showed no effect on outcomes of postoperative sepsis, shock, major complications, reoperation, and 30-day mortality. Based on these results, routine prophylactic drainage should be reconsidered for patients undergoing DP.

Keywords: distal pancreatectomy; pancreatic fistula; postoperative.

© 2020 Wiley Periodicals LLC.

Figures

Figure 1 –
Figure 1 –
Selection criteria for inclusion in the analysis.
Figure 2 –
Figure 2 –
Differences in surgical outcomes according to presence or lack of a surgicaUy placed drain at time of distai pancreatectomy. POPF, post-operative pancreatic fistula. * signifies P

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Source: PubMed

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