An audit of results of a no-drainage practice policy after hepatectomy.
BACKGROUND
It was hypothesized that routine operative drainage is unnecessary for elective hepatic resection.


METHODS
A review was made of the clinical records of patients undergoing liver resection at a tertiary referral hepatobiliary surgery center since the conclusion in April of 1994 of our previous randomized drainage trial. The main outcome measures were operative drainage versus no operative drainage assessed for possible association with diagnoses, extent of hepatectomy, hospital course, and postoperative radiologic percutaneous drainage procedures.


RESULTS
Of 1,165 patients, 184 were operatively drained with closed drains according to specific practice criteria and 981 were not subject to operative drainage. Patients who were not operatively drained had length of stay (10.1 days), mortality (2%), and complication rate (34%) comparable with the nondrained patients in the previous randomized trial. Ten percent of these patients required postoperative percutaneous drainage. Patients who were operatively drained were a group who were at higher risk for biliary leakage or infections and consequently had a significantly longer hospital stay, greater mortality, higher complication rate, and required a greater number of percutaneous abdominal drainages.


CONCLUSIONS
The 84% of patients not operatively drained had no greater adverse outcome. After hepatic resection, routine drainage of the abdomen is unnecessary.
Burt
Bryan M
BM
Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA.
Brown
Karen
K
Jarnagin
William
W
DeMatteo
Ronald
R
Blumgart
Leslie H
LH
Fong
Yuman
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009026:Mortality; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies