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

Abstract

BackgroundPostoperative 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.ObjectiveThe aim of this study is to determine if drainage helps to prevent adverse outcomes and decrease the need for additional interventions after DP.MethodsAll 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.ResultsA 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).ConclusionThe 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.

Routine abdominal drainage after distal pancreatectomy: meta-analysis

“…Mangieri et al . 16 reported a higher rate of POPF grade B/C and readmissions in the drain group. Behrman and co-workers 14 reported no difference between groups in severe morbidity and grade B/C POPF.…”

“…Pooled analysis showed that the POPF rate was lower in the no-drain group compared with the drain group (RR 0.55, 0.42 to 0.72). Readmissions were reported in three studies 1 , 16 , 17 , with a lower rate in the no-drain group (RR 0.76, 0.60 to 0.96).…”

Incidence and impact of postoperative pancreatic fistula after minimally invasive and open distal pancreatectomy

“…An evaluation of 1,158 patients undergoing distal pancreatectomy found a higher rate of POPF in the "drain group" compared to the "no drain group" (19.4% vs 6.9%, respectively; P ¼ .001). 25 A multicenter randomized trial including 344 patients found no difference in clinically relevant POPF rates between patients undergoing distal pancreatectomy with or without a drain in situ. Percutaneous drain placement and reoperation and readmission rates did not differ between the 2 groups.…”

Prophylactic Intra-Peritoneal Drainage After Pancreatic Resection: An Updated Meta-Analysis

“…Moreover, Behrman et al ( 48 ) concluded that placement of drains following elective distal pancreatectomy was associated with a higher overall morbidity and pancreatic fistulas. Mangieri et al ( 49 ) found a significant increase in the rates of readmission with the placement of surgical drain after DP. In the current study, we found that there was no significant difference between the drain group and the no-drain group in terms of mortality and morbidity, as well as bile leak, hemorrhage, DGE, intra-abdominal abscess, IR and reoperation.…”