title: Is it time to abandon routine operative drain use? A single institution assessment of 709 consecutive pancreaticoduodenectomies.
abstract: BACKGROUND
  Routine use of operative (primary) drains after pancreaticoduodenctomy (PD) remains controversial. We reviewed our experience with PD for postoperative (secondary) drainage and postoperative pancreatic fistula (POPF) rates based on use of primary drains.
  
  
  METHODS
  We identified consecutive patients who underwent PD between 2005 and 2012 from our pancreatectomy database. Primary closed suction drains were placed at the surgeon's discretion. Patient and operative factors were assessed, along with POPF, complications, and secondary drain placement rates.
  
  
  RESULTS
  There were 709 PDs performed, and 251 (35%) patients had primary drains placed. Age, sex, body mass index, and comorbidities were similar among groups; however, drained patients had slightly larger pancreatic ducts (mean diameter 3.8 mm vs 2.2 mm; p < 0.01). The overall secondary drainage rate was 7.1%. Primary drain placement did not affect the need for secondary drainage (with primary drain, 8.4% vs without primary drain 6.3%, p = 0.36), reoperation (5.6% vs 5.7%, p = 1.00), readmission (17.5% vs 16.8%, p = 0.89), or 30-day mortality (2.0% vs 2.5%, p = 0.80). When compared with the no drain group, patients with primary drains experienced higher rates of overall morbidity (68.1% vs 54.1%, p < 0.01) and significant POPF (16.3% vs 7.6%; p < 0.01), as well as longer hospital stays (13.8 days vs 11.3 days; p < 0.01). On multivariate analysis, primary drain placement remained an independent risk factor for pancreatic fistula formation (hazard ratio 3.3, p < 0.01), but did not have an impact on secondary drainage rates (p = 0.85).
  
  
  CONCLUSIONS
  Placement of closed suction drains during pancreaticoduodenectomy does not appear to decrease the rate of secondary drainage procedures or reoperation, and may be associated with increased pancreatic fistula formation and overall morbidity. These data support foregoing routine primary operative drainage at time of pancreaticoduodenectomy.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Vishes V
authors.initials: VV
authors.lastname: Mehta
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Fisher
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sarmiento
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
mesh_terms: D004322:Drainage / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011182:Postoperative Care / Q000009:adverse effects / Q000706:statistics & numerical data*; D012189:Retrospective Studies