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Should Drains Suck? A Propensity Score Analysis of Closed-Suction Versus Closed-Gravity Drainage After Pancreatectomy

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

Post-operative pancreatic fistula (POPF) remains one of the most common complications after pancreatic surgery. We previously reported that the majority of US surgeons leave drains after pancreatectomy. However, there remains controversy and surgeon bias on the use of gravity compared with suction drainage with limited data on patient outcomes to guide management.

Methods

Demographics, comorbidities, perioperative, and outcome data were captured from the most recent ACS National Surgical Quality Improvement Program (NSQIP)–targeted pancreatectomy databases. This is a retrospective cohort analysis comparing closed-suction to closed-gravity drains with multivariate analysis and propensity score matching (PSM).

Results

Of 9232 patients that underwent a pancreatectomy with closed drain placement, 1345 (15%) were to gravity and 7887 (85%) were to suction. On multivariate and PSM, stratified by surgery-type, there was no difference in biochemical leak (Whipple, 4 vs. 4%; distal, 8 vs. 6%) or clinically relevant (CR)-POPF (Whipple, 13 vs. 15%; distal, 12 vs. 15%). On multivariate analysis, there was an increase in organ-space surgical site infections with suction drains for patients undergoing Whipple procedure (12 vs. 16%, p = 0.004), which did not persist on PSM (p = 0.088). Finally, there were no significant differences in amylase level, time to drain removal, or superficial surgical site infections for patients undergoing either procedure based on drain type.

Conclusion

The majority of drains utilized after pancreatectomy in the USA are placed to suction, though a significant proportion are kept to gravity. Neither type of drain is associated with increased CR-POPF or other post-operative outcomes compared with the other; therefore, both types remain reasonable options if drains are to be placed.

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Abbreviations

POPF:

Post-operative pancreatic fistula

CR-POPF:

Clinically-relevant POPF

PJ:

Pancreaticojejunostomy

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Acknowledgments

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, Chicago, IL, USA

    Lyonell B. Kone, Vijay K. Maker & Ajay V. Maker

  2. Department of Surgery, Creticos Cancer Center at Advocate Illinois Masonic Medical Center, Chicago, IL, USA

    Lyonell B. Kone, Vijay K. Maker, Mihaela Banulescu & Ajay V. Maker

Authors
  1. Lyonell B. Kone
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  2. Vijay K. Maker
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Correspondence to Ajay V. Maker.

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The authors declare that they have no conflict of interest.

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The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Western Surgical Association (WSA). San Jose Del Cabo, Mexico. November 2018.

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Kone, L.B., Maker, V.K., Banulescu, M. et al. Should Drains Suck? A Propensity Score Analysis of Closed-Suction Versus Closed-Gravity Drainage After Pancreatectomy. J Gastrointest Surg 25, 1224–1232 (2021). https://doi.org/10.1007/s11605-020-04613-7

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  • DOI: https://doi.org/10.1007/s11605-020-04613-7

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