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Drain Placement After Pancreatic Resection: Friend or Foe For Surgical Site Infections?

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Despite multiple studies and randomized trials, there remains controversy over whether drains should be placed, and if so for how long, after pancreas resection. The aim was to determine if post-pancreatectomy drain placement and timing of drain removal were associated with differences in infectious outcomes and, if so, which specific procedures and infectious sites were most at risk.

Methods

The ACS-NSQIP targeted pancreatectomy database was utilized to identify patients who underwent pancreatectomies between 2015 and 2020 with postoperative drain placement for retrospective cohort analysis. A propensity score matching analyses was conducted to determine associations between drain placement and surgical site infections (SSI).

Results

Of 39,057 pancreatic resections, 66.4% were proximal pancreatectomies, and 33.6% were distal pancreatectomies. After propensity score matching, drain placement was not associated with significantly lower rates of superficial SSI (7% vs 9%, p = 0.755) or organ/space SSI (17% vs 16%, p = 0.647) after proximal pancreatectomy. After distal pancreatectomy, drain placement was associated with higher rates of organ/space SSI (12% vs 9%, p = 0.010). Drain removal on or after postoperative day 3 was significantly associated with higher rates of SSI in both proximal and distal pancreatectomy.

Conclusions

Drain placement is associated with an increased rate of organ/space SSI after distal pancreatectomy and not after pancreaticoduodenectomy. When drains are utilized, early removal is associated with a reduction of SSI after all types of pancreatectomy. In surgical units where post-pancreatectomy SSI is a concern, selective drain placement for high-risk glands or after distal pancreatectomy, combined with early drain removal, may be considered.

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Data Availability

The dataset analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, USA

    Tommaso Pollini, Paul Wong, Rym El Khoury & Ajay V. Maker

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

    Lyonell B. Kone, Chris Kabir, Vijay K. Maker & Mihaela Banulescu

Authors
  1. Tommaso Pollini
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  2. Paul Wong
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  3. Lyonell B. Kone
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  4. Rym El Khoury
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  5. Chris Kabir
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  6. Vijay K. Maker
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  7. Mihaela Banulescu
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  8. Ajay V. Maker
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Contributions

All authors were involved with the study design. TP and REK were involved with the data analysis and manuscript drafting. All co-authors contributed equally to the manuscript revision and approved the final version of the manuscript.

Corresponding author

Correspondence to Ajay V. Maker.

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Disclosures

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; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Conflict of Interest

The authors declare no competing interests.

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Pollini, T., Wong, P., Kone, L.B. et al. Drain Placement After Pancreatic Resection: Friend or Foe For Surgical Site Infections?. J Gastrointest Surg 27, 724–729 (2023). https://doi.org/10.1007/s11605-023-05612-0

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