Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial.
BACKGROUND
The role of surgically placed intra-abdominal drainages after pancreatic resections has not been clearly established. In particular, their effect on morbidity rates and the optimal timing for their removal remains controversial.


METHODS
A total of 114 eligible patients who underwent standard pancreatic resections and at low risk of postoperative pancreatic fistula according to our institutional protocol (amylase value in drains < or =5000 U/L on postoperative day [POD] 1) were randomized on POD 3 to receive either early (POD 3) or standard drain removal (POD 5 or beyond). The primary end point of the study was the incidence of pancreatic fistula. Secondary endpoints included abdominal complications, pulmonary complications, in-hospital stay, and perioperative mortality. Cost-analysis between the 2 groups was also made.


RESULTS
Early drain removal was associated with a decreased rate of pancreatic fistula (P = 0.0001), abdominal complications (P = 0.002), and pulmonary complications (P = 0.007). Median in-hospital stay was shorter (P = 0.018), and hospital costs decreased (P = 0.02). Mortality was nil. A significant association with pancreatic fistula was found for timing of drain removal (P < 0.001), unintentional weight decrease before surgery (P = 0.022), type of pancreas texture (P = 0.015), serum amylase levels on POD 1 (P = 0.001), and albumin levels on POD 1 (P = 0.039). Multivariate analysis showed that timing of drain removal (P = 0.0003) and unintentional weight decrease before surgery (P = 0.02) were independent risk factors of pancreatic fistula.


CONCLUSIONS
In patients at low risk of pancreatic fistula, intra-abdominal drains can be safely removed on POD 3 after standard pancreatic resections. A prolonged period of drain insertion is associated with a higher rate of postoperative complications with increased hospital stay and costs. The manuscript is a randomized trial, registered in the NLM database as NCT00931554.
Bassi
Claudio
C
Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy. claudio.bassi@univr.it
Molinari
Enrico
E
Malleo
Giuseppe
G
Crippa
Stefano
S
Butturini
Giovanni
G
Salvia
Roberto
R
Talamini
Giorgio
G
Pederzoli
Paolo
P
D000005:Abdomen; D016009:Chi-Square Distribution; D020878:Device Removal; D004322:Drainage / Q000295:instrumentation*; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods; D010185:Pancreatic Fistula / Q000453:epidemiology* / Q000517:prevention & control; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome