Evidence Versus Practice in Early Drain Removal After Pancreatectomy.
Aged
Amylases
/ analysis
Drainage
/ methods
Evidence-Based Medicine
/ methods
Female
Humans
Incidence
Male
Middle Aged
Pancreatectomy
/ adverse effects
Pancreaticoduodenectomy
/ adverse effects
Postoperative Care
/ methods
Postoperative Complications
/ epidemiology
Practice Patterns, Physicians'
/ statistics & numerical data
Prospective Studies
Registries
/ statistics & numerical data
Risk Factors
Time Factors
Treatment Outcome
Amylase
Distal pancreatectomy
Early drain removal
Pancreatoduodenectomy
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
03
04
2018
revised:
19
10
2018
accepted:
21
11
2018
pubmed:
30
1
2019
medline:
15
2
2020
entrez:
30
1
2019
Statut:
ppublish
Résumé
Early drain removal when postoperative day (POD) one drain fluid amylase (DFA) was ≤5000 U/L reduced complications in a previous randomized controlled trial. We hypothesized that most surgeons continue to remove drains late and this is associated with inferior outcomes. We assessed the practice of surgeons in a prospectively maintained pancreas surgery registry to determine the association between timing of drain removal with demographics, comorbidities, and complications. We selected patients with POD1 DFA ≤5000 U/L and excluded those without drains, and subjects without data on POD1 DFA or timing of drain removal. Early drain removal was defined as ≤ POD5. Two hundred and forty four patients met inclusion criteria. Only 90 (37%) had drains removed early. Estimated blood loss was greater in the late removal group (190 mL versus 100 mL, P = 0.005) and pathological findings associated with soft gland texture were more frequent (97 [63%] versus 35 [39%], P < 0.0001). Patients in the late drain removal group had more complications (84 [55%] versus 30 [33%], P = 0.001) including pancreatic fistula (55 [36%] versus 4 [4%], P < 0.0001), delayed gastric emptying (27 [18%] versus 3 [3%], P = 0.002), and longer length of stay (7 d versus 5 d, P < 0.0001). In subset analysis for procedure type, complications and pancreatic fistula remained significant for both pancreatoduodenectomy and distal pancreatectomy. Despite level one data suggesting improved outcomes with early removal when POD1 DFA is ≤ 5000 U/L, experienced pancreas surgeons more frequently removed drains late. This practice was associated with known risk factors (estimated blood loss, soft pancreas) and may be associated with inferior outcomes suggesting potential for improvement.
Sections du résumé
BACKGROUND
Early drain removal when postoperative day (POD) one drain fluid amylase (DFA) was ≤5000 U/L reduced complications in a previous randomized controlled trial. We hypothesized that most surgeons continue to remove drains late and this is associated with inferior outcomes.
METHODS
We assessed the practice of surgeons in a prospectively maintained pancreas surgery registry to determine the association between timing of drain removal with demographics, comorbidities, and complications. We selected patients with POD1 DFA ≤5000 U/L and excluded those without drains, and subjects without data on POD1 DFA or timing of drain removal. Early drain removal was defined as ≤ POD5.
RESULTS
Two hundred and forty four patients met inclusion criteria. Only 90 (37%) had drains removed early. Estimated blood loss was greater in the late removal group (190 mL versus 100 mL, P = 0.005) and pathological findings associated with soft gland texture were more frequent (97 [63%] versus 35 [39%], P < 0.0001). Patients in the late drain removal group had more complications (84 [55%] versus 30 [33%], P = 0.001) including pancreatic fistula (55 [36%] versus 4 [4%], P < 0.0001), delayed gastric emptying (27 [18%] versus 3 [3%], P = 0.002), and longer length of stay (7 d versus 5 d, P < 0.0001). In subset analysis for procedure type, complications and pancreatic fistula remained significant for both pancreatoduodenectomy and distal pancreatectomy.
CONCLUSIONS
Despite level one data suggesting improved outcomes with early removal when POD1 DFA is ≤ 5000 U/L, experienced pancreas surgeons more frequently removed drains late. This practice was associated with known risk factors (estimated blood loss, soft pancreas) and may be associated with inferior outcomes suggesting potential for improvement.
Identifiants
pubmed: 30694774
pii: S0022-4804(18)30843-6
doi: 10.1016/j.jss.2018.11.048
pmc: PMC6377814
mid: NIHMS1518001
pii:
doi:
Substances chimiques
Amylases
EC 3.2.1.-
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
332-339Subventions
Organisme : NIDDK NIH HHS
ID : R21 DK106650
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK108326
Pays : United States
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.
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