P. Addison1,3, P. C. Nauka1, K. Fatakhova1,3, L. Amodu1,3, N. Kohn2, H. L. Rodriguez Rilo1 2Feinstein Institute for Medical Research,Department Of Biostatistics,Manhasset, NY, USA 3Zucker School of Medicine at Hofstra/Northwell,Department Of Surgery,Hempstead, NY, USA 1Zucker School of Medicine at Hofstra/Northwell,Pancreas Disease Center,Manhasset, NY, USA
Introduction: The decisions to routinely place a drain after pancreaticoduodenectomy and how long to leave the drain remain controversial due to conflicting evidence and significant variations in clinical practice. This study aims to address those questions by utilizing a large national database and a rigorous analytical model.
Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) 2015-2016 Pancreatectomy Participant Use Data Files were utilized to identify patients who had undergone pancreaticoduodenectomy (n = 7583). Univariate and multivariate logistic regression analyses were performed to control for potential confounders and various preoperative risk factors.
Results:Of 7583 patients, drains were placed in 6666 (87.9%). Drain placement decreased the risk of developing serious morbidity (relative risk [RR] 0.73, 95% confidence interval [CI] 0.65-0.82), overall morbidity (RR 0.79, 95% CI 0.72-0.87), and organ space surgical site infection (RR 0.72, 95% CI 0.61-0.85); drain placement did not change the risk of developing a clinically relevant postoperative pancreatic fistula (RR 0.96, 95% CI 0.78-1.19). However, the duration of drain use was independently associated with serious morbidity (hazard ratio [HR] 3.06, 95% CI 2.65-3.53), overall morbidity (HR 2.48, 95% CI 2.20-2.80), and organ space surgical site infection (HR 1.47, 95% CI 1.25-1.74).
Conclusion: Routine drain placement following pancreaticoduodenectomy may decrease postoperative complications, including serious morbidity, overall morbidity, and organ space surgical site infections; however, increased drain duration was associated with serious morbidity, overall morbidity and organ space surgical site infection. These results support the routine placement and early removal of intraoperative surgical drains in pancreaticoduodenectomy.