Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Abstract

Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien–Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk.

Laparoscopic intersphincteric resection vs. transanal total mesorectal excision in overweight patients with low rectal cancer

“…The ISR group had earlier removal of the drainage tubes than the taTME group, and the same results were observed in the subgroup analysis. The placement of postoperative abdominal drains after colorectal surgery can prevent complicated abdominal blood accumulation, reduce the incidence of anastomotic leakage, and facilitate earlier detection of abdominal bleeding, anastomotic leakage or other complications (28). However, it has been suggested that the placement of postoperative abdominal drains may prolong the hospital stay and increase the risk of surgical site infection (29).…”

“…The placement of postoperative abdominal drains after colorectal surgery can prevent complicated abdominal blood accumulation, reduce the incidence of anastomotic leakage, and facilitate earlier detection of abdominal bleeding, anastomotic leakage or other complications ( 28 ). However, it has been suggested that the placement of postoperative abdominal drains may prolong the hospital stay and increase the risk of surgical site infection ( 29 ). It took longer for patients in the TaTME group to remove the drainage tubes, which may be explained by the fact that this group was within the learning curve of 50 cases.…”

The Nuts and Bolts of Implementing a Modified ERAS Protocol for Minimally Invasive Colorectal Surgery: Group Practice vs. Solo Practice

“…Once the patient can get out of bed and move well, the Foley catheter can be removed. According to the essence of the standard ERAS protocol, routine drainage is not recommended [ 37 ].…”

Antimicrobial Challenge in Acute Care Surgery

“…Furthermore, the adequateness and appropriateness of antimicrobial treatment should be re-thought daily [ 157 ]. Concerning surgical SC, the usefulness of a prophylactic drain placement after digestive surgery has long been debated [ 158 , 159 , 160 ]. Intra-abdominal drains paradoxically may promote surgical site infections [ 161 ] and increase hospital length of stay and costs [ 162 , 163 ] in several emergency scenarios, namely acute appendectomies, or cholecystectomies.…”