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Role of Drain Placement in Major Hepatectomy: A NSQIP Analysis of Procedure-Targeted Hepatectomy Cases

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Abstract

Background

The value of drain placement in hepatic surgery has not been conclusive. The aim of this study was to determine whether drain placement during major hepatectomy was associated with negative postoperative outcomes and whether its placement reduced the need for secondary procedures.

Methods

The American College of Surgeons National Surgical Quality Improvement Program Procedure-Targeted Hepatectomy Database was used to identify patients who underwent major hepatectomy. Patients were divided into two groups based on the placement of a drain during the procedure. Propensity score-matched cohorts of patients who underwent major hepatic resection with or without drain placement were created accounting for patient characteristics. The primary outcomes were 30-day postoperative complications including bile leak, post-hepatectomy liver failure, and invasive intervention as well as mortality and readmission.

Results

A total of 1005 patients underwent major hepatectomy; 500 patients (49.8 %) had prophylactic drains placed at the conclusion of the procedure. Drain placement was associated with any complication (p < 0.001), blood transfusion (p < 0.001), renal insufficiency (p = 0.02), bile leak (p < 0.001), invasive intervention (p = 0.02), length of stay (p = 0.001), and readmission (p < 0.001). In the matched cohort, drain placement was associated with any complication (p < 0.001), blood transfusion (p < 0.001), superficial surgical site infection (SSI) (p = 0.028), bile leak (p < 0.001), and longer length of stay (0.03). In addition, placement of a prophylactic drain did not decrease the rate of postoperative bile leaks requiring therapeutic intervention (p = 0.21) (Table 2). In multivariate analysis, drain placement was independently associated with any complication (p < 0.001), blood transfusion (p = 0.02), bile leak (p < 0.001), invasive intervention (p = 0.011), superficial surgical site infection (SSI) (p = 0.039), and hospital readmission (p = 0.005) (Table 3). Placement of a prophylactic drain did not decrease the rate of postoperative bile leaks requiring therapeutic intervention (p = 0.15).

Conclusion

Drain placement after major hepatectomy may lead to increased postoperative complications including bile leak, superficial surgical site infection, and hospital length of stay and does not decrease the need for secondary procedures in patients with bile leaks.

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Abbreviations

ACS-NSQIP:

American College of Surgeons National Surgical Quality Improvement Program

ERCP:

Endoscopic retrograde cholangiography

PTC:

Percutaneous transhepatic cholangiodrainage

CPT:

Current Procedural Terminology

CPR:

Cardiopulmonary resuscitation

SPSS:

Statistical package for the social sciences

OR:

Odds ratio

CI:

Confidence interval

ASA:

American Society of Anesthesia

BMI:

Body mass index

COPD:

Chronic obstructive pulmonary disease

SSI:

Surgical site infection

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Authors and Affiliations

  1. Department of Surgery, Division of General Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1041, New York, NY, 10029, USA

    Chaya Shwaartz, Adam C. Fields, Jeffrey J. Aalberg & Celia M. Divino

Authors
  1. Chaya Shwaartz
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  2. Adam C. Fields
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  3. Jeffrey J. Aalberg
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  4. Celia M. Divino
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Correspondence to Celia M. Divino.

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Shwaartz, C., Fields, A.C., Aalberg, J.J. et al. Role of Drain Placement in Major Hepatectomy: A NSQIP Analysis of Procedure-Targeted Hepatectomy Cases. World J Surg 41, 1110–1118 (2017). https://doi.org/10.1007/s00268-016-3750-4

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  • DOI: https://doi.org/10.1007/s00268-016-3750-4

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