Passive Versus Active Intra-Abdominal Drainage Following Pancreaticoduodenectomy: A Retrospective Study Using The Americ
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ORIGINAL SCIENTIFIC REPORT
Passive Versus Active Intra-Abdominal Drainage Following Pancreaticoduodenectomy: A Retrospective Study Using The American College of Surgeons NSQIP Database Madeline Lemke1 • Lily Park2 • Fady K. Balaa2,3 • Guillaume Martel2,3 • Jad Abou Khalil2,3 Kimberly A. Bertens2,3
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Accepted: 4 October 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Prophylactic drainage following pancreaticoduodenectomy (PD) reduces morbidity and mortality. Little evidence exists to advise on whether passive gravity (PG) or active suction (AS) drainage systems result in superior outcomes. This study examines the relationship between drainage system and morbidity following PD. Methods All patients undergoing elective PD with an operatively placed drain in the 2016 ACS-NSQIP database were included. Pre- and intra-operative factors were examined. Multivariable logistic regression and coarsened exact matching (CEM) were used to assess for an association between drainage system (PG vs. AS) and morbidity. The primary outcome was postoperative pancreatic fistula (POPF). Results In total, 3430 patients were included: 563 (16.4%) with PG and 2867 (83.6%) with AS drainage system. On multivariable regression, 1787 patients were included. Drainage type was not associated with POPF, surgical site infection, delayed gastric emptying, or re-operation. AS drainage was protective against percutaneous drain insertion (OR 0.65, 95% CI 0.44–0.96, p = 0.033). In the CEM cohort (n = 268), superficial SSI was higher in the AS group (0.8% vs. 6.0%, p = 0.036). There was a trend toward higher rates of composite total SSI (PG 15.7%, AS 23.9%, p = 0.092) and organ space SSI (PG 14.2%, AS 20.2%, p = 0.195) in the AS group; this did not demonstrate statistical significance. Conclusions The findings of this study suggest that AS drainage is protective against percutaneous drain insertion, but may be associated with increased risk of SSI. There was no relation between drainage type and POPF. A prospective, randomized controlled trial is warranted to further explore these findings.
Introduction
Part of this work was presented at the World Congress of the International Hepato-Pancreato-Biliary Association in Geneva, Switzerland September 2018.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00268-020-05823-5) contains supplementary material, which is available to authorized users. & Kimberly A. Bertens [email protected] 1
School of Medicine, Queen’s University, Kingston, ON, Canada
Postoperative pancreatic fistula (POPF) remains a common complication following pancreatic surgery and is the greatest contributor to postoperative morbidity following pancreaticoduodenectomy (PD) [1]. The International Study Group on Pancreatic Fistula (ISGPF) objectively defines POPF as a drain fluid amylase level at least three 2
School of Medicine, University of Ottawa, Ottawa, ON, Canada
3
Liver and Pancreas Surgical Unit, Division of General Surgery, The Ottawa Hospital – General Campu
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