Hospital variation in use of prophylactic drains following hepatectomy.
Journal
HPB : the official journal of the International Hepato Pancreato Biliary Association
ISSN: 1477-2574
Titre abrégé: HPB (Oxford)
Pays: England
ID NLM: 100900921
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
08
01
2020
revised:
12
02
2020
accepted:
14
02
2020
pubmed:
17
3
2020
medline:
26
10
2021
entrez:
17
3
2020
Statut:
ppublish
Résumé
Prophylactic drainage following hepatectomy is frequently performed despite evidence that drainage is unnecessary. It is unknown to what extent drain use is influenced by hospital practice patterns. The objectives of this study were to identify factors associated with the use of prophylactic drains following hepatectomy and assess hospital variation in drain use. Retrospective cohort study of patients following hepatectomy without concomitant bowel resection or biliary reconstruction from the ACS NSQIP Hepatectomy Targeted Dataset. Factors associated with the use of prophylactic drains were identified using multivariable logistic regression and hospital-level variation in drain use was assessed. Analysis included 10,530 patients at 130 hospitals. Overall, 42.3% of patients had a prophylactic drain placed following hepatectomy. Patients were more likely to receive prophylactic drains if they were ≥65 years old (adjusted odds ratio [aOR]: 1.34, 95%CI: 1.16-1.56), underwent major hepatectomy (aOR: 1.42, 95%CI 1.15-1.74), or had an open resection (aOR 1.94, 95%CI 1.49-2.53). There was notable hospital variability in drain use (range: 0%-100% of patients), and 77.5% of measured variation was at the hospital level. Prophylactic drains are commonly placed in both major and minor hepatectomy. Hospital-specific patterns appear to be a major driver and represent a target for improvement.
Sections du résumé
BACKGROUND
Prophylactic drainage following hepatectomy is frequently performed despite evidence that drainage is unnecessary. It is unknown to what extent drain use is influenced by hospital practice patterns. The objectives of this study were to identify factors associated with the use of prophylactic drains following hepatectomy and assess hospital variation in drain use.
METHODS
Retrospective cohort study of patients following hepatectomy without concomitant bowel resection or biliary reconstruction from the ACS NSQIP Hepatectomy Targeted Dataset. Factors associated with the use of prophylactic drains were identified using multivariable logistic regression and hospital-level variation in drain use was assessed.
RESULTS
Analysis included 10,530 patients at 130 hospitals. Overall, 42.3% of patients had a prophylactic drain placed following hepatectomy. Patients were more likely to receive prophylactic drains if they were ≥65 years old (adjusted odds ratio [aOR]: 1.34, 95%CI: 1.16-1.56), underwent major hepatectomy (aOR: 1.42, 95%CI 1.15-1.74), or had an open resection (aOR 1.94, 95%CI 1.49-2.53). There was notable hospital variability in drain use (range: 0%-100% of patients), and 77.5% of measured variation was at the hospital level.
CONCLUSION
Prophylactic drains are commonly placed in both major and minor hepatectomy. Hospital-specific patterns appear to be a major driver and represent a target for improvement.
Identifiants
pubmed: 32173175
pii: S1365-182X(20)30056-3
doi: 10.1016/j.hpb.2020.02.006
pmc: PMC8385641
mid: NIHMS1730037
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1471-1479Subventions
Organisme : AHRQ HHS
ID : K12 HS026385
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : AHRQ HHS
ID : T32 HS000078
Pays : United States
Informations de copyright
Copyright © 2020 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of Interest None declared.
Références
Obesity (Silver Spring). 2014 Jul;22 Suppl 2:S40
pubmed: 24961824
Cancer. 2008 Oct 1;113(7 Suppl):1888-96
pubmed: 18798530
World J Surg. 2017 Apr;41(4):1110-1118
pubmed: 27738836
J Am Coll Surg. 2013 Aug;217(2):336-46.e1
pubmed: 23628227
Am J Surg. 1996 Jan;171(1):158-62
pubmed: 8554132
World J Surg. 2016 Jan;40(1):172-81
pubmed: 26148518
Hepatogastroenterology. 2014 May;61(131):707-11
pubmed: 26176061
Ann Surg. 2004 Dec;240(6):1074-84; discussion 1084-5
pubmed: 15570212
J Visc Surg. 2015 Nov;152(5):305-13
pubmed: 26481067
World J Surg. 2016 Jan;40(1):182-9
pubmed: 26159119
HPB (Oxford). 2013 Mar;15(3):224-9
pubmed: 23374363
Surgery. 2011 May;149(5):680-8
pubmed: 21316725
Cochrane Database Syst Rev. 2007 Jul 18;(3):CD006232
pubmed: 17636837
HPB (Oxford). 2015 Jan;17(1):46-51
pubmed: 25059275
J Am Coll Surg. 2015 Apr;220(4):396-402
pubmed: 25724607
Ann Surg. 2004 Feb;239(2):194-201
pubmed: 14745327
J Am Coll Surg. 2016 Dec;223(6):774-783.e2
pubmed: 27793459
Br J Surg. 2006 Apr;93(4):422-6
pubmed: 16491462
Am J Surg. 1994 Jun;167(6):593-5
pubmed: 8209934
J Surg Res. 2015 Jun 15;196(2):221-8
pubmed: 25881789
World J Surg. 1982 Jan;6(1):54-60
pubmed: 7090396
Yearb Med Inform. 2000;(1):65-70
pubmed: 27699347
Ann Surg. 2001 Jan;233(1):45-50
pubmed: 11141224
Arch Surg. 2006 Jul;141(7):690-4; discussion 695
pubmed: 16847242
Ann Surg. 1993 Dec;218(6):748-53
pubmed: 8257225
Ann Surg. 2002 Oct;236(4):397-406; discussion 406-7
pubmed: 12368667
Ann Surg. 1994 Aug;220(2):199-205
pubmed: 8053742