255 International Variation in Intraperitoneal Drain Placement and Outcomes After Elective Colorectal Surgery: A Matched, Prospective, Cohort Study

Abstract

Background Currently, many surgeons place intraperitoneal drains after elective colorectal surgery. However, Enhanced Recovery After Surgery (ERAS) guidelines recommend against their routine use due to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Method COMPlicAted intra-abdominal collectionS after colorectal Surgery (COMPASS) was a prospective, international, cohort study which enrolled consecutive adult patients undergoing elective colorectal surgery (February-March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time-to-diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time-to-discharge; 30-day major postoperative complications (Clavien–Dindo grade ≥3). After propensity-score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 [44.2%] female; median age 67.0 years). The drain insertion rate was 51.9% (n=937). After matching, drains were not associated with reduced rates (OR 1.33, 95% CI: 0.79–2.23, p=0.287) or earlier detection of collections (HR 0.87, 95% CI: 0.33–2.31, p=0.780). Although not associated with worse major postoperative complications (OR 1.09, 95% CI: 0.68–1.75, p=0.709), drains were associated with delayed hospital discharge (HR 0.58, 95% CI: 0.52–0.66, p<0.001) and increased risk of SSIs (OR 2.47, 95% CI: 1.50–4.05, p<0.001). Conclusions Intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of collections but were associated with prolonged length of stay and increased SSI risk.

Risk Factors for Rectal Stump Leakage following Discontinuity Resection: Stump Length Matters Most

“…The benefit of percutaneous and transanal drainages in elective colorectal surgery regarding AL is controversial. [33][34][35][36][37][38] In our collective, prophylactic RS drainage did not reduce RSL. In fact, irrigation-suction and transanal drains were associated with increased RSL rates; however, it is for now unclear whether they causally contribute to RSL (ie, via mechanical irritation, foreign body reaction, or transdermal infection) or whether they are intentionally and more frequently placed in high-risk constellations.…”

Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS®) Society Recommendations Part 2—Emergency Laparotomy: Intra‐ and Postoperative Care

“…In fact, in patients undergoing elective surgery, evidence for any of the proposed beneficial effects is lacking or weak; in general, patients with intra‐abdominal drains have been found to have similar rates of mortality, morbidity, infections, anastomotic leaks, and re‐interventions as patients without drains [65–68] and a meta‐analysis of 4 RCTs in patients undergoing rectal surgery found no benefits from closed suction drains [69]. In a recent prospective international matched cohort study of 1805 patients undergoing elective colorectal surgery, drains were not associated with reduced rates or earlier detection of collections and were associated with delayed hospital discharge and an increased risk of surgical site infection [70].…”

Acute PresentatiOn of coLorectaL cancer ‐ an internatiOnal snapshot (APOLLO): Protocol for a prospective, multicentre cohort study

“…APOLLO will be delivered through the well-established collaborative research model which has been validated across several international cohort studies [21,22]. This model facilitates the inclusion of large numbers of patients in "snapshot" research studies across short study periods, particularly advantageous in low-incidence presentations such as acutely presenting CRC.…”