The role of abdominal drainage in pancreatic resection – A multicenter validation study for early drain removal

Linnemann, R.; Patijn, Gijs A.; Rijssen, L.B. van; Besselink, Marc G.; Mungroop, Timothy H.; Hingh, Ignace H. J. T. de; Kazemier, Geert; Festen, Sebastiaan; Jong, Koert P. de; Eijck, Casper H.J. van; Scheepers, Joris J.; Kolk, M. van der; Dulk, Marcel den; Bosscha, K.; Busch, Olivier R.; Boerma, Djamila; Harst, Erwin van der; Nieuwenhuijs, Vincent B.

doi:10.1016/j.pan.2019.07.041

Cited by 28 publications

(14 citation statements)

References 18 publications

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“…While the actual need for drain placement after pancreaticoduodenectomy (PD) is still a matter of some debate, it remains standard practice [1,2]. The drain output after PD is easily assessable after PD, and among measurements of the drain output, the International Study Group of Pancreatic Surgery (ISGPS) proposed the definition of postoperative pancreatic fistula (POPF) using drain amylase (DA) on postoperative day (POD)3 [3].…”

Section: Introductionmentioning

confidence: 99%

Drain output volume after pancreaticoduodenectomy is a useful warning sign for postoperative complications

et al. 2021

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Introduction The drain output volume (DOV) after pancreaticoduodenectomy (PD) is an easily assessable indicator in clinical settings. We explored the utility of the DOV as a possible warning sign of complications after PD. Methods A total of 404 patients undergoing PD were considered for inclusion. The predictability of the DOV for overall morbidity, major complications, intraabdominal infection (IAI), clinically relevant (CR) postoperative pancreatic fistula (POPF), CR delayed gastric emptying (DGE), CR chyle leak (CL), and CR post-pancreatectomy hemorrhaging (PPH) was evaluated. Results One hundred (24.8%) patients developed major complications, and 131 (32.4%) developed IAI. Regarding CR post-pancreatectomy complications, 75 (18.6%) patients developed CR-POPF, 23 (5.7%) developed CR-DGE, 20 (5.0%) developed CR-CL, and 28 (6.9%) developed CR-PPH. The median DOV on postoperative day (POD) 1 and POD 3 was 266 and 234.5 ml, respectively. A low DOV on POD 1 was an independent predictor of CR-POPF, and a high DOV on POD 3 was an independent predictor of CR-CL. A receiver operating characteristics (ROC) analysis revealed that the DOV on POD 1 had a negative predictive value (area under the curve [AUC] 0.655, sensitivity 65.0%, specificity 65.3%, 95% confidence interval [CI]: 0.587–0.724), with a calculated optimal cut-off value of 227 ml. An ROC analysis also revealed that the DOV on POD 3 had a positive predictive value (AUC 0.753, sensitivity 70.1%, specificity 75.0%, 95% CI: 0.651–0.856), with a calculated optimal cut-off value of 332 ml. Conclusion A low DOV on POD 1 might be a postoperative warning sign for CR-POPF, similar to high drain amylase (DA) on POD 1, high DA on POD 3, and high CRP on POD 3. When the DOV on POD 1 after PD was low, surgeons should evaluate the reasons of a low DOV. A high DOV on POD 3 was a postoperative warning sign CR-CL, and might require an appropriate management of protein loss.

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Section: Introductionmentioning

confidence: 99%

Drain output volume after pancreaticoduodenectomy is a useful warning sign for postoperative complications

et al. 2021

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“…It has proven that DFA is the reliable index that could predict the occurrence of CR-POPF. Several reports have shown that high postoperative DFA is an independent risk factor associated with CR-POPF [12][13][14]31]. CAR, calculated by dividing the serum CRP level by the serum albumin level, which means dividing the positive and negative acute-phase reactants [32][33][34], reflects the acute inflammatory intensity [35], incorporating individual differences.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have conventionally used some of the indexes that are constant to predict the occurrence of POPF in a static way [8][9][10]. Among them, postoperative drainage fluid amylase (DFA) and C-reactive protein-to-serum-albumin ratio (CAR) seemed to be the accurate and widely used indexes for the prediction of CR-POPF, especially in a particular time-point, in which they are suggested to be useful and critical predictive indexes [11][12][13][14]. However, preoperative and intraoperative factors indicating CR-POPF seemed to vary [15][16][17][18], furthermore, such prediction result cannot be updated according to the changes in the patient's fluctuating state and examination results over time.…”

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confidence: 99%

Dynamic prediction for clinically relevant pancreatic fistula: a novel prediction model for laparoscopic pancreaticoduodenectomy

Liu

Cai

et al. 2021

BMC Surg

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Background With the recent emerge of dynamic prediction model on the use of diabetes, cardiovascular diseases and renal failure, and its advantage of providing timely predicted results according to the fluctuation of the condition of the patients, we aim to develop a dynamic prediction model with its corresponding risk assessment chart for clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy by combining baseline factors and postoperative time-relevant drainage fluid amylase level and C-reactive protein-to-albumin ratio. Methods We collected data of 251 patients undergoing LPD at West China Hospital of Sichuan University from January 2016 to April 2019. We extracted preoperative and intraoperative baseline factors and time-window of postoperative drainage fluid amylase and C-reactive protein-to-albumin ratio relevant to clinically relevant pancreatic fistula by performing univariate and multivariate analyses, developing a time-relevant logistic model with the evaluation of its discrimination ability. We also established a risk assessment chart in each time-point. Results The proportion of the patients who developed clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy was 7.6% (19/251); preoperative albumin and creatine levels, as well as drainage fluid amylase and C-reactive protein-to-albumin ratio on postoperative days 2, 3, and 5, were the independent risk factors for clinically relevant postoperative pancreatic fistula. The cut-off points of the prediction value of each time-relevant logistic model were 14.0% (sensitivity: 81.9%, specificity: 86.5%), 8.3% (sensitivity: 85.7%, specificity: 79.1%), and 7.4% (sensitivity: 76.9%, specificity: 85.9%) on postoperative days 2, 3, and 5, respectively, the area under the receiver operating characteristic curve was 0.866 (95% CI 0.737–0.996), 0.896 (95% CI 0.814–0.978), and 0.888 (95% CI 0.806–0.971), respectively. Conclusions The dynamic prediction model for clinically relevant postoperative pancreatic fistula has a good to very good discriminative ability and predictive accuracy. Patients whose predictive values were above 14.0%, 8.3%, and 7.5% on postoperative days 2, 3, and 5 would be very likely to develop clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy.

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“…Multiple RCTs have shown that early mobilisation is feasible, safe and effective in critically ill patient and patients in the surgical intensive care unit, reducing their ICU stay, increasing their muscle strength, and increasing their readiness for discharge [201][202][203][204][205]. Finally, early drain removal may aid with mobilisation by reducing the number of tubes connected to the patient while appearing to have no clear impact on outcomes after pancreatic surgery [206][207][208][209][210]. A Cochrane review of prophylactic abdominal drainage in pancreatic surgery found no difference in 30-day mortality, LOS or post-operative complications [206].…”

Section: Postoperative Mobilisationmentioning

confidence: 99%

Working towards an ERAS Protocol for Pancreatic Transplantation: A Narrative Review

Elango

Papalois

2021

JCM

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Enhanced recovery after surgery (ERAS) initially started in the early 2000s as a series of protocols to improve the perioperative care of surgical patients. They aimed to increase patient satisfaction while reducing postoperative complications and postoperative length of stay. Despite these protocols being widely adopted in many fields of surgery, they are yet to be adopted in pancreatic transplantation: a high-risk surgery with often prolonged length of postoperative stay and high rate of complications. We have analysed the literature in pancreatic and transplantation surgery to identify the necessary preoperative, intra-operative and postoperative components of an ERAS pathway in pancreas transplantation.

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The role of abdominal drainage in pancreatic resection – A multicenter validation study for early drain removal

Cited by 28 publications

References 18 publications

Drain output volume after pancreaticoduodenectomy is a useful warning sign for postoperative complications

Drain output volume after pancreaticoduodenectomy is a useful warning sign for postoperative complications

Dynamic prediction for clinically relevant pancreatic fistula: a novel prediction model for laparoscopic pancreaticoduodenectomy

Working towards an ERAS Protocol for Pancreatic Transplantation: A Narrative Review

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