title: Predictors of the Effectiveness of Prophylactic Drains After Hepatic Resection.
abstract: BACKGROUND
  Randomized clinical trials have demonstrated the limited efficacy of prophylactic drains following hepatic resection. However, many surgeons still insist on using prophylactic drains. This study was designed to identify patients who require prophylactic drains to manage or monitor postoperative complications after hepatic resection.
  
  
  METHODS
  Data were retrospectively collected from 316 patients who underwent hepatic resection and received a prophylactic drain. The patients were divided into two groups according to whether the drain was used to manage or monitor the following postoperative complications: bile leakage (prophylactic drains were used to monitor and treat bile leakage) and postoperative hemorrhage (the drainage fluid was macroscopically bloody and required drain fluid blood counts and monitoring to assess the need for transfusion or reoperation). The results were then validated in a separate cohort of 101 patients.
  
  
  RESULTS
  In 25/316 patients (7.9 %), the prophylactic drains were clinically effective, being used to manage bile leakage in 18 patients and hemorrhage in 8. Intraoperative bile leakage (P = 0.021) and long operation time (≥ 360 min) (P = 0.017) were independent predictors of bile leakage. Intraoperative blood loss (≥ 650 ml) (P = 0.0009) was an independent predictor of hemorrhage. In the subsequent 101 patients, prophylactic drains were clinically effective in patients with one of these predictors with sensitivity, specificity, and false-negative rates of 88.9, 62.0, and 1.7 %, respectively.
  
  
  CONCLUSIONS
  A prophylactic drain should be considered following hepatic resection for patients with intraoperative bile leakage, operation time of ≥ 360 min, or blood loss of ≥ 650 ml.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan, y-bekki@surg2.med.kyushu-u.ac.jp.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Bekki
authors.forename: Yo-Ichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Shinji
authors.initials: S
authors.lastname: Itoh
authors.forename: Norifumi
authors.initials: N
authors.lastname: Harimoto
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000175:diagnosis / Q000628:therapy*; D001646:Bile; D016063:Blood Loss, Surgical; D004322:Drainage; D005188:False Negative Reactions; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity