title: Impact of routine use of surgical drains on incidence of complications with robot-assisted radical prostatectomy.
abstract: OBJECTIVE
  To assess the impact of eliminating routine drain placement in patients undergoing robot-assisted laparoscopic prostatectomy (RALP) and pelvic lymph node dissection (PLND) on the risk of postoperative complications.
  
  
  METHODS
  An experienced single surgeon performed RALP on 651 consecutive patients at our institution from 2008 to 2012. Before August 2011, RALP with or without PLND included a routine peritoneal drain placed during surgery. Thereafter, routine intraoperative placement of drains was omitted, except for intraoperatively noted anastomotic leakage. We used multivariable logistic regression to compare complication rates between study periods and the actual drain placement status after adjusting for standard prespecified covariates.
  
  
  RESULTS
  Most patients (92%) did not have ≥grade 2 complications after surgery and only two patients (0.3%) experienced a grade 4 complication. The absolute adjusted risk of a grade 2-5 complication was 0.9% greater among those treated before August 2011 (95% confidence interval [CI] -3.3%-5.1%; p=0.7), while absolute adjusted risk of a grade 3-5 complication was 2.8% less (-2.8%; 95% CI-5.3%-0.1%; p=0.061). RESULTS based on drain status were similar.
  
  
  CONCLUSIONS
  Routine peritoneal drain placement following RALP with PLND did not confer a significant advantage in terms of postoperative complications. Further data are necessary to confirm that it is safe to omit drains in most patients.
authors.affiliation: 1 Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center , New York, New York.
authors.forename: John E
authors.initials: JE
authors.lastname: Musser
authors.forename: Melissa
authors.initials: M
authors.lastname: Assel
authors.forename: Giuliano B
authors.initials: GB
authors.lastname: Guglielmetti
authors.forename: Prachee
authors.initials: P
authors.lastname: Pathak
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Silberstein
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Sjoberg
authors.forename: Melanie
authors.initials: M
authors.lastname: Bernstein
authors.forename: Vincent P
authors.initials: VP
authors.lastname: Laudone
mesh_terms: D000328:Adult; D000368:Aged; D004322:Drainage / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures