A prospective comparative study of routine versus deferred pelvic drain placement after radical prostatectomy: impact on
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ORIGINAL ARTICLE
A prospective comparative study of routine versus deferred pelvic drain placement after radical prostatectomy: impact on complications and opioid use Mitchell M. Huang1 · Hiten D. Patel1 · Zhuo T. Su1 · Christian P. Pavlovich1 · Alan W. Partin1 · Phillip M. Pierorazio1 · Mohamad E. Allaf1 Received: 18 June 2020 / Accepted: 3 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To evaluate the association of post-RP drain placement with post-operative complications and opioid use at a high-volume institution. Methods A prospective, comparative cohort study of patients undergoing robot-assisted or open RP was conducted. Patients for two surgeons did not routinely receive pelvic drains (“No Drain” arm), while the remainder routinely placed drains (“Drain” arm). Outcomes were evaluated at 30 days including Clavien–Dindo complications and opioid use. Intention-to-treat primary analysis and additional secondary analyses were performed using appropriate statistical tests and logistic regression. Results Of 498 total patients, 144 (28.9%) were in the No Drain arm (all robot-assisted) and 354 (71.1%) in the Drain arm. In the No Drain arm, 19 (13.2%) intraoperatively were chosen to receive drains. There was no difference in overall or major (Clavien ≥ 3) complications between groups (p = 0.2 and 0.4, respectively). Drain deferral did not predict complications on multivariable analysis adjusted for age, BMI, comorbidities, clinical risk, surgical approach, operating time, lymphadenectomy, and number of nodes removed [OR 0.61, 95% CI 0.34–1.11, p = 0.10]; nor did it predict symptomatic fluid collection, adjusting for lymphadenectomy and nodes removed [OR 1.14, 95% CI 0.43–3.60, p = 0.8]. Drain deferral did not decrease opioid use (p = 0.5). Per protocol analysis and restriction to robot-assisted cases demonstrated similar results. Conclusion There was no difference in adverse events, complications, symptomatic collections, or opioid use with deferral of routine drain placement after RP. Experienced surgeons may safely defer drain placement in the majority of robot-assisted RP cases. Keywords Prostate cancer · Radical prostatectomy · Robotic surgery · Drains · Complications · Pain
Introduction Radical prostatectomy (RP) is the standard extirpative treatment for clinically localized prostate cancer and one of the most widely performed urologic procedures [1]. Since the Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03439-x) contains supplementary material, which is available to authorized users. * Mitchell M. Huang [email protected] 1
Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD 21287, USA
introduction of RP, improvements in surgical technique have resulted in better outcomes for patients, including reduced rates of incontinence and erectile dysfunction. In recent years, the int
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