Use of primary surgical drains in synchronous resection for colorectal liver metastases: a NSQIP analysis of current pra
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and Other Interventional Techniques
Use of primary surgical drains in synchronous resection for colorectal liver metastases: a NSQIP analysis of current practice paradigm Elliott J. Yee1 · Mohammed H. Al‑Temimi1 · Katelyn F. Flick1 · E. Molly Kilbane2 · Trang K. Nguyen1 · Nicholas J. Zyromski1 · C. Max Schmidt1 · Attila Nakeeb1 · Michael G. House1 · Eugene P. Ceppa1,3 Received: 7 June 2020 / Accepted: 17 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background There are no studies examining the use of subhepatic drains after simultaneous resection of synchronous colorectal liver metastases (sCRLM). This study aimed to (1) describe the current practices regarding primary drain placement, (2) evaluate drain efficacy in mitigating postoperative complications, and (3) determine impact of drain maintenance duration on patient outcomes. Methods The ACS-NSQIP targeted data from 2014 to 2017 were analyzed. Propensity score of surgical drain versus no drain cohorts was performed. Main study outcomes were mortality, major morbidity, organ/space surgical site infection (SSI), secondary drain/aspiration procedure, and any septic events. Additional univariate/multivariate logistic analyses were performed to identify associations with drain placement and duration. Major hepatectomy was defined as formal right hepatectomy and any trisectionectomy. Results 584 combined liver and colorectal resection (CRR) cases were identified. Open partial hepatectomy with colectomy was the most common procedure (70%, n = 407). Nearly 40% of patients received surgical drains (n = 226). Major hepatectomy, lower serum albumin, and no intraoperative portal vein occlusion (Pringle maneuver) were significantly associated with drain placement (p 13) was defined as severely prolonged removal. We regarded primary outcomes as 30-day mortality, occurrence of major morbidity, organ/space SSI, occurrence of sepsis/septic shock, and need for postoperative drainage or aspiration. Secondary outcomes were bile leak, reoperation, readmission, and length of hospital stay (LOS).
Statistical analysis Bivariate analysis was performed using Chi-squared or Fisher’s exact test for categorical data, and Student’s T or Wilcox rank-sum test for comparison of continuous variables where appropriate. Post hoc analysis with Bonferroni correction was utilized after Chi-square analysis to detect statistically significant pairwise differences in postoperative outcomes between no drain placement, early, late, and severely prolonged drain removal groups. Kruskal–Wallis test was employed to compare LOS between the POD drain removal intervals. All multivariable logistic regression analyses were performed with backward elimination and included variables with p values 5 Neoadjuvant chemotherapy*, n Liver texture*, n Normal or fatty Congested or cirrhotic Preoperative sodium*, mEq/L, mean ± SD Preoperative BUN*, mg/dL, mean ± SD Preop bili* (mg/dL) Preop platelets*, K/cumm, mean ± SD Early vs. late drain removal* E – POD0-7 L – POD
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