Skip to main content

Advertisement

SpringerLink
Log in

Trends and Variations in Drain Use Following Pancreatoduodenectomy: Is Early Drain Removal Becoming More Common?

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Although previous studies have noted the potential benefit of early drain removal (EDR) after pancreatoduodenectomy (PD), there is a paucity of data on the timing of drain removal utilizing a national database that reflect the “real world” setting. Given the ongoing controversy related to PD drain use and management, we sought to define trends in drain use among a large national cohort, as well as identify factors associated with EDR following PD.

Methods

The ACS NSQIP targeted pancreatectomy database was used to identify patients who underwent PD between 2014 and 2020. The trend in proportion of patients with EDR (removal ≤ POD3) as well as predictors of EDR were assessed. Risk-adjusted postoperative outcomes were evaluated by multivariable regression analysis.

Results

Among 14,356 patients, 16.2% of patients (N = 2324) experienced EDR, and the proportion of patients with EDR increased by 68% over the study period (2014: 10.9% vs. 2020: 18.3%, p < 0.001). Higher drain fluid amylase on POD1-3 [LogWorth (LW) = 44.3], operative time (LW = 33.2), and use of minimally invasive surgery (LW = 14.0) were associated with EDR. Additionally, EDR was associated with decreased risk of overall and serious morbidity, PD-related morbidity (e.g., pancreatic fistula), reoperation, prolonged length of stay and readmission (all p < 0.05).

Conclusions

Routine drain placement remains a common practice among most surgeons. EDR following PD increased over time was associated with lower post-operative complications and shorter LOS. Despite evidence that EDR was safe and may even be associated with lower complications, only 1 in 6 patients were managed with EDR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Seykora TF, Ecker BL, McMillan MT et al (2019) The beneficial effects of minimizing blood loss in pancreatoduodenectomy. Ann Surg 270:147–157

    Article  PubMed  Google Scholar 

  2. Shrikhande SV, Sivasanker M, Vollmer CM et al (2017) Pancreatic anastomosis after pancreatoduodenectomy: a position statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 161:1221–1234

    Article  PubMed  Google Scholar 

  3. Casciani F, Bassi C, Vollmer CM (2021) Decision points in pancreatoduodenectomy: Insights from the contemporary experts on prevention, mitigation, and management of postoperative pancreatic fistula. Surgery 170:889–909

    Article  PubMed  Google Scholar 

  4. Beane JD, House MG, Ceppa EP et al (2019) Variation in drain management after pancreatoduodenectomy: early versus delayed removal. Ann Surg 269:718–724

    Article  PubMed  Google Scholar 

  5. McMillan MT, Malleo G, Bassi C et al (2017) Multicenter, prospective trial of selective drain management for pancreatoduodenectomy using risk stratification. Ann Surg 265:1209–1218

    Article  PubMed  Google Scholar 

  6. Kawai M, Tani M, Terasawa H et al (2006) Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg 244:1–7

    Article  PubMed  PubMed Central  Google Scholar 

  7. Raval MV, Pawlik TM (2018) Practical guide to surgical data sets: National Surgical Quality Improvement Program (NSQIP) and pediatric NSQIP. JAMA Surg 153:764–765

    Article  PubMed  Google Scholar 

  8. Sellers MM, Merkow RP, Halverson A et al (2013) Validation of new readmission data in the American College of Surgeons national surgical quality improvement program. J Am Coll Surg 216:420–427

    Article  PubMed  Google Scholar 

  9. Ingraham AM, Richards KE, Hall BL et al (2010) Quality improvement in surgery: the American College of Surgeons national surgical quality improvement program approach. Adv Surg 44:251–267

    Article  PubMed  Google Scholar 

  10. Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161:584–591

    Article  PubMed  Google Scholar 

  11. Sahara K, Merath K, Hyer JM et al (2020) Impact of surgeon volume on outcomes and expenditure among medicare beneficiaries undergoing liver resection: the effect of minimally invasive surgery. J Gastrointest Surg 24:1520–1529

    Article  PubMed  Google Scholar 

  12. Kantor O, Talamonti MS, Pitt HA et al (2017) Using the NSQIP pancreatic demonstration project to derive a modified fistula risk score for preoperative risk stratification in patients undergoing pancreaticoduodenectomy. J Am Coll Surg 224:816–825

    Article  PubMed  Google Scholar 

  13. Jackson TD, Wannares JJ, Lancaster RT et al (2011) Does speed matter? The impact of operative time on outcome in laparoscopic surgery. Surg Endosc 25:2288–2295

    Article  PubMed  PubMed Central  Google Scholar 

  14. Toyoda J, Sahara K, Tsilimigras DI et al (2021) Survival benefit of primary tumor resection among elderly patients with pancreatic neuroendocrine tumors. World J Surg 45:3643–3651

    Article  PubMed  Google Scholar 

  15. Ogawa S, Itabashi M, Bamba Y et al (2020) Superior prognosis stratification for stage III colon cancer using log odds of positive lymph nodes (LODDS) compared to TNM stage classification: the Japanese study group for postoperative follow-up of colorectal cancer. Oncotarget 11:3144–3152

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sahara K, Paredes AZ, Tsilimigras DI et al (2021) Machine learning predicts unpredicted deaths with high accuracy following hepatopancreatic surgery. Hepatobiliary Surg Nutr 10:20–30

    Article  PubMed  PubMed Central  Google Scholar 

  17. Simons JP, Shah SA, Ng SC et al (2009) National complication rates after pancreatectomy: beyond mere mortality. J Gastrointest Surg 13:1798

    Article  PubMed  Google Scholar 

  18. Van Buren II G, Bloomston M, Hughes SJ et al (2014) A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg 259:605–612

    Article  PubMed  Google Scholar 

  19. McMillan MT, Fisher WE, Van Buren G et al (2015) The value of drains as a fistula mitigation strategy for pancreatoduodenectomy: something for everyone? Results of a randomized prospective multi-institutional study. J Gastrointest Surg 19:21–31

    Article  PubMed  Google Scholar 

  20. Villafane-Ferriol N, Baugh KA, McElhany AL et al (2019) Evidence versus practice in early drain removal after pancreatectomy. J Surg Res 236:332–339

    Article  PubMed  PubMed Central  Google Scholar 

  21. Dai M, Liu Q, Xing C et al (2022) Early drain removal is safe in patients with low or intermediate risk of pancreatic fistula after pancreaticoduodenectomy: a multicenter, randomized controlled trial. Ann Surg 275:e307–e314

    Article  PubMed  Google Scholar 

  22. Callery MP, Pratt WB, Kent TS et al (2013) A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 216:1–14

    Article  PubMed  Google Scholar 

  23. McMillan MT, Soi S, Asbun HJ et al (2016) Risk-adjusted outcomes of clinically relevant pancreatic fistula following pancreatoduodenectomy: a model for performance evaluation. Ann Surg 264:344–352

    Article  PubMed  Google Scholar 

  24. Bassi C, Molinari E, Malleo G et al (2010) Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg 252:207–214

    Article  PubMed  Google Scholar 

  25. Trudeau MT, Maggino L, Chen B et al (2020) Extended experience with a dynamic, data-driven selective drain management protocol in pancreaticoduodenectomy: progressive risk stratification for better practice. J Am Coll Surg 230:809-818.e801

    Article  PubMed  Google Scholar 

  26. Guo W, Ye X, Li J et al (2022) Comparison of surgical outcomes among open, laparoscopic, and robotic pancreatoduodenectomy: a single-center retrospective study. BMC Surg 22:348

    Article  PubMed  PubMed Central  Google Scholar 

  27. Yan JF, Pan Y, Chen K et al (2019) Minimally invasive pancreatoduodenectomy is associated with lower morbidity compared to open pancreatoduodenectomy: an updated meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Medicine (Baltimore) 98:e16730

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None

Funding

None

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery Division, Yokohama City University School of Medicine, 3 Chome-9 Fukuura, Kanazawa Ward, Yokohama, Kanazawa, 236-0004, Japan

    Kota Sahara, Kentaro Miyake, Junya Toyoda, Yasuhiro Yabushita, Yuki Homma, Takafumi Kumamoto, Ryusei Matsuyama & Itaru Endo

  2. Department of Surgery, Saiseikai Yokohamashi Nanbu Hospital, 3 Chome-2-10 Konandai, Konan Ward, Yokohama, Kanagawa, 234-0054, Japan

    Kota Sahara

  3. Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave, Columbus, OH, 43210, USA

    Kota Sahara, Samantha M. Ruff & Timothy M. Pawlik

Authors
  1. Kota Sahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samantha M. Ruff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kentaro Miyake
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Junya Toyoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasuhiro Yabushita
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuki Homma
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takafumi Kumamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ryusei Matsuyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Itaru Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Timothy M. Pawlik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timothy M. Pawlik.

Ethics declarations

Conflict of interest

None of the authors have any conflicts of interest to report.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Trend in proportion of patients drain removed by postoperative day 3 and 5 over time (n=14,356) (TIF 53 KB)

268_2023_6966_MOESM2_ESM.tif

Trend in drain use stratified by removal timing (EDR or no-EDR ) and drain removal location (inpatient or outpatient) (TIF 52 KB)

Supplementary file3 (DOCX 14 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sahara, K., Ruff, S.M., Miyake, K. et al. Trends and Variations in Drain Use Following Pancreatoduodenectomy: Is Early Drain Removal Becoming More Common?. World J Surg 47, 1772–1779 (2023). https://doi.org/10.1007/s00268-023-06966-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-023-06966-x

Search

Navigation