V. J. Parikh1, K. Baugh1, G. Van Buren1, A. McElhany1, N. Villafane-Ferriol1, E. Williams1, S. Mohamed1, H. Tran Cao1, E. Silberfein1, C. Hsu1, C. Chai1, N. Massarweh1, W. E. Fisher1 1Baylor College Of Medicine,Michael E. DeBakey Department Of Surgery,Houston, TX, USA
Introduction: Intra-abdominal drains decrease morbidity and mortality in patients who develop a post-operative pancreatic fistula (POPF) following pancreaticoduodenectomy (PD). However, the prolonged use of drains in patients who do not develop a POPF may cause complications. We hypothesized that use of multiple abdominal drains would improve outcomes in patients at high risk for POPF.
Methods: A prospectively maintained pancreas surgery database was retrospectively reviewed. Patients undergoing PD were divided into two groups based on the placement of one or two abdominal drains at the time of resection. Subjects were sub-stratified for risk of POPF in two separate ways: a validated FRS and postoperative day 1 drain fluid amylase concentration (DFA). Within similar risk cohorts, patients with two intra-operative drains were compared to those with one. Outcomes were compared using chi-square or Fisher’s exact tests for categorical variables and Student’s t-test for continuous variables.
Results: A total of 480 patients were included, 204 (42%) had one drain and 276 (58%) had two drains placed at the time of surgery. Using the FRS, 171 patients (36%) were in the negligible-low risk group and 309 (64%) were in the moderate-high risk group. Using DFA, 321 (84%) patients were in the low-risk group and 59 (16%) were in the high-risk group. Regardless of the method of risk stratification, use of two drains compared to one in high risk patients did not decrease the occurrence of post-operative complications. In addition, use of two drains in patients with low risk was associated with increased POPF and intra-abdominal abscesses.
Conclusion: Two intra-operative drains may not mitigate post-operative complications better than one drain in high risk patients following PD and might be associated with greater morbidity in lower risk patients.
