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Variation in Drain Management Among Patients Undergoing Major Hepatectomy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Although previous studies have suggested that drain management is highly variable, data on drain placement and timing of drain removal among patients undergoing hepatic resection remain scarce. The objective of the current study was to define the utilization of drain placement among patients undergoing major hepatic resection.

Methods

The ACS NSQIP-targeted hepatectomy database was used to identify patients who underwent major hepatectomy between 2014 and 2017. Association between day of drain removal, timing of discharge, and drain fluid bilirubin on postoperative day (POD) 3 (DFB-3) was assessed. Propensity score matching (PSM) was used to compare outcomes of patients with a drain removed before and after POD 3.

Results

Among 5330 patients, most patients had an abdominal drain placed at the time of hepatic resection (n = 3075, 57.7%). Of 2495 patients with data on timing of drain removal, only 380 patients (15.2%) had their drain removed by POD 3. Almost 1 in 6 patients (n = 441, 17.7%) were discharged home with the drain in place. DFB-3 values correlated poorly with POD of drain removal (R2 = 0.0049). After PSM, early drain removal (≤ POD 3) was associated with lower rates of grade B or C bile leakage (2.1% vs. 7.1%, p = 0.008) and prolonged length of hospital stay (6.0% vs. 12.7%, p = 0.009) compared with delayed drain removal (> POD 3).

Conclusions

Roughly 3 in 5 patients had a drain placed at the time of major hepatectomy and only 1 in 7 patients had the drain removed early. This study demonstrated the potential benefits of early drain removal in an effort to improve the quality of care following major hepatectomy.

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Author notes

  1. Kota Sahara and Diamantis I. Tsilimigras contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Kota Sahara, Diamantis I. Tsilimigras, Amika Moro, Rittal Mehta, J. Madison Hyer, Anghela Z. Paredes, Joal D. Beane & Timothy M. Pawlik

  2. Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan

    Kota Sahara & Itaru Endo

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  1. Kota Sahara
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  2. Diamantis I. Tsilimigras
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  3. Amika Moro
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Correspondence to Timothy M. Pawlik.

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Precis: The current study showed that considerable variation existed in the use of drain placement and timing of surgical drain removal after major hepatectomy. This study also demonstrated the potential benefits of early drain removal following major hepatectomy.

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Sahara, K., Tsilimigras, D.I., Moro, A. et al. Variation in Drain Management Among Patients Undergoing Major Hepatectomy. J Gastrointest Surg 25, 962–970 (2021). https://doi.org/10.1007/s11605-020-04610-w

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