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

Kone, Lyonell; Maker, Vijay K.; Banulescu, Mihaela; Maker, Ajay V.

doi:10.1007/s11605-020-04613-7

Cited by 18 publications

(26 citation statements)

References 28 publications

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“…In the single-institution retrospective study by Schmidt and colleagues, gravity drainage was associated with lower rates of POPF (14% vs. 3%), but also correlated with higher volume surgeons, raising concerns about gravity drainage acting as a surrogate for procedure volume. 13 Though multiple authors have recently published results suggesting no differences in outcomes between drainage methods following pancreatectomy, 15,21 neither study differentiated between types of pancreatectomy operations. As numerous reports have revealed substantial differences in drain usage and POPF rates between PD and distal pancreatectomy, this suggests that PD and distal pancreatectomy should be studied as two distinct operations.…”

Section: Resultsmentioning

confidence: 99%

“…9,10 Previous randomized trials evaluating drainage type were limited by small sample size or showed rates of CR-POPF higher than those typically seen in US hospitals, 21 while previous registry studies have used the ACS-NSQIP de nition of CR-POPF, which is recognized to have signi cant limitations. 15,19 Our study addresses the limitations of prior work by using a large, validated, international surgical registry of pancreas surgery to increase sample size, studies a selected population of PD procedures only, and utilizes a rigorous de nition of CR-POPF. 20 In contrast to recent research, the results herein suggest a consistent small but signi cant association between closed-suction drainage and higher rates of multiple complications following PD.…”

Section: Resultsmentioning

confidence: 99%

“…12,13 In contrast, other authors have not demonstrated differences in POPF rates between closed-suction and gravity drains in mixed cohorts of pancreatectomy. 15 However, the majority of these series have evaluated drain suction across small patient cohorts or diverse pancreatectomy procedures, rather than pancreaticoduodenectomy (PD) alone.…”

Section: Introductionmentioning

confidence: 99%

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Association of Gravity Drainage and Complications Following Whipple: An Analysis of the ACS-NSQIP Targeted Database

Egr

Krell

et al. 2020

Preprint

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Background: The optimal type of operative drainage following pancreaticoduodenectomy (PD) remains unclear. Our objective is to investigate risk associated with closed drainage techniques (passive [gravity] vs. suction) after PD.Methods: We assessed operative drainage techniques utilized in patients undergoing PD in the ACS-NSQIP Pancreas-Targeted database from 2016-2018. Using multivariable logistic regression to adjust for characteristics of the patient, procedure, and pancreas, we examined the association between use of gravity drainage and postoperative outcomes.Results: We identified 9,665 patients with drains following PD from 2016-2018, of which 12.7% received gravity drainage. 61.0% had a diagnosis of adenocarcinoma or pancreatitis, 26.5% had a duct <3 mm, and 43.5% had a soft or intermediate gland. After multivariable adjustment, gravity drainage was associated with decreased rates of postoperative pancreatic fistula (odds ratio [OR] 0.804, 95% Confidence Interval [CI] 0.659-0.981, P= 0.031), delayed gastric emptying (OR 0.830, 95%CI 0.693-0.988, P= 0.036), superficial SSI (OR: 0.741, 95% CI: 0.572-0.959, P=0.023), organ space SSI (OR: 0.791, 95% CI: 0.658-0.951, P=0.012), and readmission (OR: 0.807, 95% CI: 0.679-0.958, P=0.014) following PD.Conclusions: Gravity drainage is independently associated with decreased rates of CR-POPF, DGE, SSI, and readmission following PD. Additional prospective research will help determine which method is preferred.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of Gravity Drainage and Complications Following Whipple: An Analysis of the ACS-NSQIP Targeted Database

Egr

Krell

et al. 2020

Preprint

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“…There were no data on the type of drain suction used after pancreatectomy in our institution. However, Kone et al 26…”

Section: Discussionmentioning

confidence: 97%

“…There were no data on the type of drain suction used after pancreatectomy in our institution. However, Kone et al 26 recently analyzed closed suction vs closed gravity drainage after pancreatectomy in a large sample. They showed that the type of drain is not associated with increased CR‐POPF or other postoperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

Which is the best predictor of clinically relevant pancreatic fistula after pancreatectomy: drain fluid concentration or total amount of amylase?

Fukami

Saito

Osawa

et al. 2021

Annals of Gastroent Surgery

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Passive Versus Active Intra‐Abdominal Drainage Following Pancreatic Resection: Does A Superior Drainage System Exist? A Systematic Review and Meta‐Analysis

et al. 2021

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Postoperative pancreatic fistula (POPF) is a major source of morbidity following pancreatic resection. Surgically placed drains under suction or gravity are routinely used to help mitigate the complications associated with POPF. Controversy exists as to whether one of these drain management strategies is superior. The objective was to identify and compare the incidence of POPF, adverse events, and resource utilization associated with passive gravity (PG) versus active suction (AS) drainage following pancreatic resection. MEDLINE, EMBASE, CINAHL, and Cochrane Library databases were searched from inception to May 18, 2020. Outcomes of interest included POPF, post‐pancreatectomy hemorrhage (PPH), surgical site infection (SSI), other major morbidity, and resource utilization. Descriptive qualitative and pooled quantitative meta‐analyses were performed. One randomized control trial and five cohort studies involving 10 663 patients were included. Meta‐analysis found no difference in the odds of developing POPF between AS and PG (p = 0.78). There were no differences in other endpoints including PPH (p = 0.58), SSI (wound p = 0.21, organ space p = 0.05), major morbidity (p = 0.71), or resource utilization (p = 0.72). The risk of POPF or other adverse outcomes is not impacted by drain management following pancreatic resection. Based on current evidence, a suggestion cannot be made to support the use of one drain over another at this time. There is a trend toward increased intra‐abdominal wound infections with AS drains (p = 0.05) that merits further investigation.

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

Cited by 18 publications

References 28 publications

Association of Gravity Drainage and Complications Following Whipple: An Analysis of the ACS-NSQIP Targeted Database

Association of Gravity Drainage and Complications Following Whipple: An Analysis of the ACS-NSQIP Targeted Database

Which is the best predictor of clinically relevant pancreatic fistula after pancreatectomy: drain fluid concentration or total amount of amylase?

Passive Versus Active Intra‐Abdominal Drainage Following Pancreatic Resection: Does A Superior Drainage System Exist? A Systematic Review and Meta‐Analysis

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