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.
Similar content being viewed by others
References
McMillan MT, Christein JD, Callery MP, Behrman SW, Drebin JA, Hollis RH et al (2016) Comparing the burden of pancreatic fistulas after pancreatoduodenectomy and distal pancreatectomy. Surgery 159(4):1013–22. https://doi.org/10.1016/j.surg.2015.10.028
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M et al (2017) The 2016 update of the international study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–91. https://doi.org/10.1016/j.surg.2016.11.014
Van Buren G, Bloomston M, Hughes SJ, Winter J, Behrman SW, Zyromski NJ et al (2014) A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg 259(4):605–12
Van Buren G, Bloomston M, Schmidt CR, Behrman SW, Zyromski NJ, Ball CG et al (2017) A prospective randomized multicenter trial of distal pancreatectomy with and without routine intraperitoneal drainage. Ann Surg 266(3):1
Witzigmann H, Diener MK, Kienkotter S, Rossion I, Bruckner T, Barbel W et al (2016) No need for routine drainage after pancreatic head resection: the dual-center, randomized, controlled PANDRA trial (ISRCTN04937707). Ann Surg 264(3):528–37
Conlon KC, Labow D, Leung D, Smith A, Jarnagin W, Coit DG et al (2001) Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 234(4):487–94
Peng S, Cheng Y, Yang C, Lu J, Wu S, Zhou R, Cheng N (2015) Prophylactic abdominal drainage for pancreatic surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD010583.pub2
Cheng Y, Xia J, Lai M, Cheng N, He S (2016) Prophylactic abdominal drainage for pancreatic surgery. Cochrane Database Syst Rev 10(10):CD010583
Zhang W, He S, Cheng Y, Xia J, Lai M, Cheng N et al (2018) Prophylactic abdominal drainage for pancreatic surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD010583.pub4
Villafane-Ferriol N, Shah RM, Mohammed S, Van Buren G, Barakat O, Massarweh NN et al (2018) Evidence-based management of drains following pancreatic resection: a systematic review. Pancreas 47(1):12–7
McMillan MT, Soi S, Asbun HJ, Ball CG, Bassi C, Beane JD et al (2016) Risk-adjusted outcomes of clinically relevant pancreatic fistula following pancreatoduodenectomy: a model for performance evaluation. Ann Surg 264(2):344–52
Čečka F, Jon B, Skalický P, Čermáková E, Neoral Č, Loveček M (2018) Results of a randomized controlled trial comparing closed-suction drains versus passive gravity drains after pancreatic resection. Surgery 164(5):1057–63
Čečka F, Jon B, Šubrt Z, Ferko A, Loveček M, Skalický P et al (2015) Intra-abdominal drainage following pancreatic resection: a systematic review. World J Gastroenterol 21(40):11458–68
Aumont O, Dupré A, Abjean A, Pereira B, Veziant J, Le Roy B et al (2017) Does intraoperative closed-suction drainage influence the rate of pancreatic fistula after pancreaticoduodenectomy? BMC Surg 17(1):4–9
Vanbrugghe C, Ronot M, Cauchy F, Hobeika C, Dokmak S, Aussilhou B et al (2019) Visceral obesity and open passive drainage increase the risk of pancreatic fistula following distal pancreatectomy. J Gastrointest Surg 23(7):1414–1424
Whitson BA, Richardson E, Iaizzo PA, Hess DJ (2009) Not every bulb is a rose: a functional comparison of bulb suction devices. J Surg Res 156(2):270–3. https://doi.org/10.1016/j.jss.2009.03.096
American College of Surgeons National Surgical Quality Improvement Program (2017) User guide for the 2016 ACS NSQIP procedure targeted participant use file. https://www.facs.org/quality-programs/acs-nsqip/participant-use
Shiloach M, Frencher SK, Steeger JE, Rowell KS, Bartzokis K, Tomeh MG et al (2010) Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 210(1):6–16. https://doi.org/10.1016/j.jamcollsurg.2009.09.031
Henderson WG, Daley J (2009) Design and statistical methodology of the national surgical quality improvement program: why is it what it is? Am J Surg 198(5 SUPPL):S19-27. https://doi.org/10.1016/j.amjsurg.2009.07.025
Davenport DL, Holsapple CW, Conigliaro J (2009) Assessing surgical quality using administrative and clinical data sets: a direct comparison of the university healthsystem consortium clinical database and the national surgical quality improvement program data set. Am J Med Qual 24(5):395–402
Cohen ME, Ko CY, Bilimoria KY, Zhou L, Huffman K, Wang X et al (2013) Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. J Am Coll Surg 217(2):336–46
Nicholls SG, Quach P, von Elm E, Guttmann A, Moher D, Petersen I et al (2015) The reporting of studies conducted using observational routinely-collected health data (RECORD) statement: methods for arriving at consensus and developing reporting guidelines. PLoS One 10(5):e0125620. https://doi.org/10.1371/journal.pone.0125620
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the international study group of pancreatic surgery (ISGPS). Surgery 142(5):761–768
van der Gaag NA, Kloek JJ, de Bakker JK, Musters B, Geskus RB, Busch ORC et al (2012) Survival analysis and prognostic nomogram for patients undergoing resection of extrahepatic cholangiocarcinoma. Ann Oncol 23(10):2642–9. https://doi.org/10.1093/annonc/mds077
Iacus SM, King G, Porro G (2012) Causal inference without balance checking: coarsened exact matching. Polit Anal 20(1):1–24
Iacus SM, King G, Porro G (2009) CEM: software for coarsened exact matching. J Stat Softw. https://doi.org/10.18637/jss.v030.i09
Di Martino M, Mora-Guzman I, Blanco-Traba Y, Díaz M, Khurram M, Martín-Pérez E (2019) Predictive factors of pancreatic fistula after pancreaticoduodenectomy and external validation of predictive scores. Anticancer Res 39(1):499–504
Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM (2013) A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 216(1):1–14. https://doi.org/10.1016/j.jamcollsurg.2012.09.002
Correa-Gallego C, Brennan MF, D’Angelica M, Fong Y, Dematteo RP, Kingham TP et al (2013) Operative drainage following pancreatic resection: analysis of 1122 patients resected over 5 years at a single institution. Ann Surg 258(6):1051–8
Marchegiani G, Perri G, Pulvirenti A, Sereni E, Azzini AM, Malleo G et al (2018) Non-inferiority of open passive drains compared with closed suction drains in pancreatic surgery outcomes: aprospective observational study. Surgery 164(3):443–9. https://doi.org/10.1016/j.surg.2018.04.025
Menard S (2002) Applied logistic regression analysis, 2nd edn. Sage Publications, Thousand Oaks
Finks JF, Osborne NH, Birkmeyer JD (2011) Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med 364(22):2128–37. https://doi.org/10.1056/NEJMsa1010705
Kopp W, Van Meel M, Putter H, Samuel U, Arbogast H, Schareck W et al (2017) Center volume is associated with outcome after pancreas transplantation within the eurotransplant region. Transplantation 101(6):1247–1253
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Lemke, M., Park, L., Balaa, F.K. et al. Passive Versus Active Intra-Abdominal Drainage Following Pancreaticoduodenectomy: A Retrospective Study Using The American College of Surgeons NSQIP Database. World J Surg 45, 554–561 (2021). https://doi.org/10.1007/s00268-020-05823-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-020-05823-5