SSAT - Does Routine Drainage of the Operative Bed Following Elective Distal Pancreatectomy Reduce Complications? - an Analysis of the ACS-NSQIP Pancreatectomy Demonstration Project

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Does Routine Drainage of the Operative Bed Following Elective Distal Pancreatectomy Reduce Complications? - an Analysis of the ACS-NSQIP Pancreatectomy Demonstration Project
Stephen W. Behrman^*¹, Ben Zarzaur¹, Abhishek Parmar², Taylor S. Riall², Bruce L. Hall³, Henry Pitt⁴
¹Surgery, University of Tennessee Health Science Center, Memphis, TN; ²Surgery, University of Texas Medical Branch, Galveston, TX; ³Surgery, Washington University School of Medicine, Seattle, WA; ⁴Surgery, Temple University School of Medicine, Philadelphia, PA

Routine drainage of the operative bed and its impact on morbidity and mortality following elective pancreatectomy remains controversial. Data specific to those having distal pancreatectomy (DP) have not been presented in subset analyses in series inclusive of both left and right pancreas resections. A previous retrospective study suggested no benefit to drain placement in DP. We sought to examine if prophylactic drainage confers a reduction in postoperative complications in a multi-institutional collaborative. Methods: The American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project database was utilized to analyze the impact of drain placement on patients undergoing elective DP from November 2011-December 2012. Propensity scores for drain placement were calculated using the following variables: age, gender, race, body mass index (BMI), operative duration, presence of a concurrent organ or vascular resection, pre-operative albumin, pancreas texture and duct size, and pathology. Nearest neighbor matching was used to create a matched cohort based on drain placement. Outcomes examined focused on post-operative pancreatic fistula (PF), intrabdominal septic morbidity, and the need for percutaneous drainage and/or reoperation. The matched cohort was compared using bivariate and logistic regression analyses. Significance was assessed at the 95th percentile. Results: During the study period 761 patients from 43 institutions having DP were accrued - 606 of whom received a prophylactic drain. Propensity score matching was possible in 116 patients. After matching, drain and no drain groups were not different with respect to age, BMI, gland texture, operative time or the need for concurrent organ or vascular resection. PF were significantly more common in those that received a drain (Table). The placement of a prophylactic drain did not reduce the incidence of organ space or deep incisional infection nor the need for post-operative percutaneous drainage or reoperation. In the matched cohort, there was no mortality in either the drain or no drain group. Conclusions: In a propensity-score matched analysis of a multi-institutional cohort, the placement of drains in the operative bed following elective DP was associated with a higher PF rate but did not reduce intrabdominal septic morbidity or the need for post-operative percutaneous drainage or reoperation.

*PF Organ space SSI Deep incisional SSI Percutaneous drainage Re-operation
Drain (n=116) 21 10 1 14 1
No drain (n=116) 7 4 3 9 1

PF - pancreatic fistula, SSI - surgical site infection, *p<.05

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