Association of gravity drainage and complications following Whipple: an analysis of the ACS-NSQIP targeted database

Abstract

Background The optimal type of operative drainage following pancreaticoduodenectomy (PD) remains unclear. Our objective is to investigate risk associated with closed drainage techniques (passive [gravity] vs. suction) after PD. Methods We assessed operative drainage techniques utilized in patients undergoing PD in the ACS-NSQIP pancreas-targeted database from 2016 to 2018. Using multivariable logistic regression to adjust for characteristics of the patient, procedure, and pancreas, we examined the association between use of gravity drainage and postoperative outcomes. Results We identified 9665 patients with drains following PD from 2016 to 2018, of which 12.7% received gravity drainage. 61.0% had a diagnosis of adenocarcinoma or pancreatitis, 26.5% had a duct <3 mm, and 43.5% had a soft or intermediate gland. After multivariable adjustment, gravity drainage was associated with decreased rates of postoperative pancreatic fistula (odds ratio [OR] 0.779, 95% confidence interval [CI] 0.653–0.930, p=0.006), delayed gastric emptying (OR 0.830, 95% CI 0.693–0.988, p=0.036), superficial SSI (OR 0.741, 95% CI 0.572–0.959, p=0.023), organ space SSI (OR 0.791, 95% CI 0.658–0.951, p=0.012), and readmission (OR 0.807, 95% CI 0.679–0.958, p=0.014) following PD. Conclusions Gravity drainage is independently associated with decreased rates of CR-POPF, DGE, SSI, and readmission following PD. Additional prospective research is necessary to better understand the preferred drainage technique following PD.

Morbidity of colectomy during pancreatoduodenectomy: An analysis of the pancreas‐targeted American College of Surgeons National Surgical Quality Improvement Program Registry

“…In 2014, the ACS‐NSQIP released the pancreatectomy‐targeted database which includes all pancreatectomy cases from select centers. These targeted files contain additional variables useful for the analysis of pancreatic surgery outcomes not included in the general ACS‐NSQIP files 13,19,20 . The pancreatectomy‐targeted files were merged with the general ACS‐NSQIP files for this study.…”

“…These targeted files contain additional variables useful for the analysis of pancreatic surgery outcomes not included in the general ACS-NSQIP files. 13,19,20 The pancreatectomy-targeted files were merged with the general ACS-NSQIP files for this study.…”

Letter to the Editor: Passive Versus Active Intra‐abdominal Drainage Following Pancreaticoduodenectomy: A Retrospective Study Using the American College of Surgeons NSQIP Database

“…The authors concluded that AS drainage is protective against percutaneous drain insertion but may be associated with increased risk of surgical site infection (SSI). The article by Lemke et al is one of four articles [1][2][3][4] published over a period of approximately one year on the same topic and based on variables collected from the pancreatectomy database of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). The four articles collected data from different periods of the ACS-NSQIP: (2016) [1], (2016-2017) [2,3], (2016-2018) [4].…”

“…The four articles collected data from different periods of the ACS-NSQIP: (2016) [1], (2016-2017) [2,3], (2016-2018) [4]. While drawing from the same source (ACS-NSQIP), the four articles reached different conclusions on the results of the postoperative outcome of the use of closed PG or AS drainage systems: no difference [2,3]; AS drainage is protective against percutaneous drain insertion but may be associated with increased risk of SSI [1]; PG drainage is independently associated with decreased rates of clinically relevant-POPF (CR-POPF), delayed gastric emptying (DGE), SSI and readmission following PD [4].…”

“…The article by Lemke et al is one of four articles [1][2][3][4] published over a period of approximately one year on the same topic and based on variables collected from the pancreatectomy database of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). The four articles collected data from different periods of the ACS-NSQIP: (2016) [1], (2016-2017) [2,3], (2016-2018) [4]. While drawing from the same source (ACS-NSQIP), the four articles reached different conclusions on the results of the postoperative outcome of the use of closed PG or AS drainage systems: no difference [2,3]; AS drainage is protective against percutaneous drain insertion but may be associated with increased risk of SSI [1]; PG drainage is independently associated with decreased rates of clinically relevant-POPF (CR-POPF), delayed gastric emptying (DGE), SSI and readmission following PD [4].…”