title: Routine drainage of the operative bed following elective distal pancreatectomy does not reduce the occurrence of complications.
abstract: BACKGROUND
  Routine drainage of the operative bed following elective pancreatectomy remains controversial. Data specific to distal pancreatectomy (DP) have not been examined in a multi-institutional collaborative.
  
  
  METHODS
  Data from the American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project were utilized. The impact of drain placement on development of pancreatectomy-related and overall morbidity were analyzed. Propensity scores for drain placement were calculated, and nearest neighbor matching was used to create a matched cohort. Groups were compared using bivariate and logistic regression analyses.
  
  
  RESULTS
  Over 14 months, 761 patients undergoing DP were accrued; 606 were drained. Propensity score matching was possible in 116 patients. Drain and no drain groups were not different with respect to multiple preoperative and operative variables. All pancreatic fistulas (p < 0.01) and overall morbidity (p < 0.05) were more common in patients who received a drain. The placement of a drain did not reduce the incidence of clinically relevant pancreatic fistula nor the need for postoperative procedures.
  
  
  CONCLUSIONS
  Placement of drains following elective distal pancreatectomy was associated with a higher overall morbidity and pancreatic fistulas. Drains did not reduce intra-abdominal septic morbidity, clinically relevant pancreatic fistulas, nor the need for postoperative therapeutic intervention.
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA, sbehrman@uthsc.edu.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Behrman
authors.forename: Ben L
authors.initials: BL
authors.lastname: Zarzaur
authors.forename: Abhishek
authors.initials: A
authors.lastname: Parmar
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Riall
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Hall
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
mesh_terms: D000368:Aged; D004322:Drainage / Q000379:methods*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D010190:Pancreatic Neoplasms / Q000601:surgery; D010865:Pilot Projects; D057216:Propensity Score; D058996:Quality Improvement; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology