Operative drainage following pancreatic resection: analysis of 1122 patients resected over 5 years at a single institution.
BACKGROUND
The only prospective randomized trial evaluating the use of intraperitoneal drainage following pancreatic resection was published from our institution approximately 10 years ago. The current study sought to evaluate the evolution of practice over the last 5 years.


METHODS
Between June 2006 and June 2011, there were 1122 resections performed. Six surgeons were evenly grouped and compared by practice pattern: routine drainers (drains placed > 95%), selective drainers, and routine nondrainers (drains placed ∼15%). Prospectively recorded preoperative, operative, and morbidity data were assessed in uni- and multivariate models.


RESULTS
Our operative drainage rate was 49% and decreased over time (62% 2006-2008 vs 37% 2009-2011, P < 0.001). Patients without operative drains had significantly lower grade ≥3 overall morbidity (26% vs 33%; P = 0.01), shorter hospital stays (7 vs 8 days; P < 0.01), fewer readmissions (20% vs 27%; P = 0.01), and lower rates of grade ≥3 pancreatic fistula (16% vs 20%; P = 0.05). Similar reoperation (both <1%), interventional radiology procedures (15% vs 19%; P = 0.1), and mortality rates (2% vs 1%; P = 0.3) were seen in both groups. There were no differences between the routine drainers group (n = 248) and the nondrainers group (n = 478) in grade ≥3 fistula or need for interventional radiology-guided procedures.


CONCLUSIONS
In this study, operative drains were used nearly half of the time and were associated with longer hospital stay, and higher grade ≥3 morbidity, fistula, and readmission rates. They did not decrease the need for reintervention or alter mortality rates. Routine prophylactic drainage after pancreatic resection could be safely abandoned.
From the Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
Camilo
C
Correa-Gallego
Murray F
MF
Brennan
Michael
M
Dʼangelica
Yuman
Y
Fong
Ronald P
RP
Dematteo
T Peter
TP
Kingham
William R
WR
Jarnagin
Peter J
PJ
Allen
D000368:Aged; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D010180:Pancreatectomy / Q000379:methods; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome