The safety of the early removal of prophylactic drainage after liver resection based solely on predetermined criteria: a propensity score analysis

Hokuto, Daisuke; Nomi, Takeo; Yasuda, Satoshi; Kawaguchi, Chihiro; Yoshikawa, Takahiro; Ishioka, Kohei; Obara, Shinsaku; Yamada, Takatsugu; Kanehiro, Hiromichi

doi:10.1016/j.hpb.2016.12.005

Cited by 21 publications

(8 citation statements)

References 16 publications

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“…Most patients were removed from the peritoneal drainage tube 5 days after surgery. There was a report that drain removal on postoperative day 3 was based on the volume and a safe bile concentration, [ 34 ] also suggesting that a drainage volume <102 mL is the only key predictor of spontaneous closure.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and a simple model for predicting bile leakage after radical hepatectomy in patients with hepatic alveolar echinococcosis

Qiu

Wang

et al. 2017

Medicine

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Postoperative bile leakage (BL) is a major complication of hepatic alveolar echinococcosis (HAE). The purpose of this study was to identify the risk factors for BL and to establish a simple scoring system for predicting BL.A total of 152 patients with HAE were included in the study between May 2004 and December 2016. The patient's baseline data, laboratory blood tests, imaging features, and surgical management were collected. Univariate and multivariate analyses were used to screen for factors to predict BL. The cutoff values for those factors and predictive value of a model were determined by receiver operative characteristic curve (ROC) analysis.BL was detected in 22 of the 152 patients. Univariate analyses showed significant differences in the lesion diameter, levels of lactate dehydrogenase (LDH), alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase and direct bilirubin (DBIL), inferior vena cava invasion, surface area of hepatectomy, blood loss and history of percutaneous transhepatic cholangial drainage between patients with and without BL. On multivariate analyses, DBIL > 7.1 μmol/L, LDH > 194 U/L, lesion diameter > 12 cm and a larger surface area of hepatectomy were independent predictors of BL. The resulting area under the ROC of the scoring model was 0.724 (95% CI, 0.646–0.793).The lesion diameter, DBIL, larger surface area of hepatectomy, and elevated LDH were the important factors affecting the occurrence of BL after surgery. The risk score model will help the clinician to assess BL before surgery. More studies are needed to confirm the scoring model and risk factors.

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Section: Discussionmentioning

confidence: 99%

Risk factors and a simple model for predicting bile leakage after radical hepatectomy in patients with hepatic alveolar echinococcosis

Qiu

Wang

et al. 2017

Medicine

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“…Another group from Japan built upon this concept but took into account drain volume and compared drain bilirubin to serum bilirubin. 12 They found that drain removal on POD 3 was safe if the drainage was <500 ml on that day and if the bilirubin concentration of the drain was less than three times the serum bilirubin concentration.…”

Section: Discussionmentioning

confidence: 99%

“…Other Japanese reports suggest that drain management can be guided by drain volume and bilirubin concentrations. 12,13 Hokuto et al demonstrated that abdominal drains could be removed safely on postoperative day (POD) 3 if the drain bilirubin concentration is less than three times serum bilirubin with a volume of <500 ml on that day. 12 Furthermore, Yamazaki et al established that early drain removal was safe if drain bilirubin concentration was less than 3 mg/dl on POD 3.…”

Section: Introductionmentioning

confidence: 99%

“…12,13 Hokuto et al demonstrated that abdominal drains could be removed safely on postoperative day (POD) 3 if the drain bilirubin concentration is less than three times serum bilirubin with a volume of <500 ml on that day. 12 Furthermore, Yamazaki et al established that early drain removal was safe if drain bilirubin concentration was less than 3 mg/dl on POD 3. 13 This '3 × 3 Rule' was validated in a follow up study by Mitsuka et al with favorable outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Early drain removal after hepatectomy: an underutilized management strategy

Fagenson

Gleeson

Lau

et al. 2020

HPB

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Background: Recent data suggest that routine drainage is unnecessary in patients undergoing hepatectomy, but many surgeons continue to utilize drains. We compared the outcomes of patients undergoing early versus routine drain removal after hepatectomy.Methods: Patients having drains placed during major (3 segments) or partial hepatectomy (2 segments) were identified in the 2014-16 ACS-NSQIP database. Propensity matching between early (POD 0-3) and routine (POD 4-7) drain removal and multivariable regressions were performed.Results: Early drain removal was performed in 661 (40%) of patients undergoing a partial hepatectomy and 211 (22%) of major hepatectomy patients. After matching, 719 early and 719 routine drain removal patients were compared. Early drain removal patients had lower overall (12 vs 19%, p < 0.001) and serious (9 vs 13%, p < 0.03) morbidity as well as fewer bile leaks (2.1% vs 5.0%, p < 0.003). Length of stay was two days shorter (4 vs 6 days, p < 0.01) and readmissions were less frequent (5.4 vs 8.1%, p = 0.02) for patients undergoing early drain removal. Conclusion:Early drain removal is associated with fewer overall and serious complications, shorter length of stay and fewer readmissions. Early drain removal after hepatectomy is an underutilized management strategy.

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“…Meanwhile, the timing of drain removal on the incidence of retrograde infection should also be considered. Several studies have illustrated the criteria for drain removal after liver resection based on fluid volume and drain fluid bilirubin level, and the time is mainly on post-operative day 3 (11)(12)(13).…”

mentioning

confidence: 99%

Prophylactic antibiotics and abdominal drainage in early recovery pathway for hepatectomy

Wang

Liu

2018

Hepatobiliary Surg. Nutr.

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The safety of the early removal of prophylactic drainage after liver resection based solely on predetermined criteria: a propensity score analysis

Abstract: Drain removal on POD 3 based on the volume and bile concentration is safe.

Cited by 21 publications

References 16 publications

Risk factors and a simple model for predicting bile leakage after radical hepatectomy in patients with hepatic alveolar echinococcosis

Risk factors and a simple model for predicting bile leakage after radical hepatectomy in patients with hepatic alveolar echinococcosis

Early drain removal after hepatectomy: an underutilized management strategy

Prophylactic antibiotics and abdominal drainage in early recovery pathway for hepatectomy

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