Drain Management Following Distal Pancreatectomy: Characterization of Contemporary Practice and Impact of Early Removal
Annals of Surgery, ISSN: 1528-1140, Vol: 272, Issue: 6, Page: 1110-1117
2020
- 33Citations
- 40Captures
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Example: if you select the 1-year option for an article published in 2019 and a metric category shows 90%, that means that the article or review is performing better than 90% of the other articles/reviews published in that journal in 2019. If you select the 3-year option for the same article published in 2019 and the metric category shows 90%, that means that the article or review is performing better than 90% of the other articles/reviews published in that journal in 2019, 2018 and 2017.
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Metrics Details
- Citations33
- Citation Indexes33
- 33
- CrossRef27
- Captures40
- Readers40
- 30
- 10
Article Description
Objective:To explore contemporary drain management practices and examine the impact of early removal following distal pancreatectomy (DP).Background:Despite accruing evidence supporting its benefit following pancreatoduodenectomy, early drain removal after DP has yet to be explored.Methods:The American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) was queried for elective DPs from 2014 to 2017. When possible, data were linked to survey responses regarding drain management from hepato-pancreato-biliary (HPB) surgeons in the ACS-NSQIP HPB Collaborative conducted in 2017. The independent association between timing of drain removal and patients' outcomes was investigated through multivariable analyses and propensity-score matching.Results:Of 5581 DPs identified, 4708 (84.4%) patients received intraoperative drains and early removal (≤ POD3) was performed in 716 (15.2%). Drain fluid amylase was recorded on POD1 for 1285 (27.3%) patients who received drains. The overall rates of death or serious morbidity (DSM) and clinically-relevant fistula (CR-POPF) were 19.5% and 17.0%. Early removal demonstrated significantly better outcomes when compared to late removal and no drain placement for: DSM, CR-POPF, delayed gastric emptying, percutaneous drainage, length of stay, and readmission. On multivariable analysis, early removal demonstrated reduced odds of developing DSM (OR = 0.41, 95% CI = 0.26-0.65) and CR-POPF (OR = 0.33, 95% CI = 0.18-0.61) compared to no drain placement, while late removal displayed increased odds for CR-POPF (OR = 2.15, 95% CI = 1.27-3.61) when compared to no drain placement. After propensity-score matching, early removal was associated with reduced odds for CR-POPF (OR = 0.35, 95% CI = 0.17-0.73).Conclusion:Although not yet widely implemented, early drain removal after distal pancreatectomy is associated with better outcomes. This study demonstrates the potential benefits of early removal and provides a substrate to define best practices and improve the quality of care for DP.
Bibliographic Details
http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85096152080&origin=inward; http://dx.doi.org/10.1097/sla.0000000000003205; http://www.ncbi.nlm.nih.gov/pubmed/30943185; https://journals.lww.com/10.1097/SLA.0000000000003205; https://dx.doi.org/10.1097/sla.0000000000003205; https://journals.lww.com/annalsofsurgery/Abstract/2020/12000/Drain_Management_Following_Distal_Pancreatectomy_.36.aspx
Ovid Technologies (Wolters Kluwer Health)
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