Impact of Drain Placement and Duration on Outcomes After Pancreaticoduodenectomy: A National Surgical Quality Improvement Program Analysis
Impact of Drain Placement and Duration on Outcomes After Pancreaticoduodenectomy: A National Surgical Quality Improvement Program Analysis
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DOI：
10.1016/j.jss.2019.04.071
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发表时间：
2019-11-01
影响因子：
2.2
通讯作者：
Rilo, Horacio L. Rodriguez
中科院分区：
文献类型：
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作者：
Addison, Poppy;Nauka, Peter C.;Rilo, Horacio L. Rodriguez
背景资料：由于相互矛盾的证据和临床实践中的显著差异，胰腺炎切除术后常规放置引流管的决定以及放置引流管的时间仍然存在争议。本研究旨在解决这些问题，通过使用一个大型的国家数据库和严格的分析model.Methods：美国外科医生学会国家外科手术质量改进计划2015-2016年胰腺切除术参与者使用数据文件被用来确定谁经历了pancreaticostomy（n = 7583）的患者。进行单变量和多变量二项回归分析，以控制潜在的混杂因素和各种术前风险因素。考克斯回归与排水管作为一个时间依赖性的协变量，条件有一个排水管放置，被用来检查之间的关联排水管留在原地和morbidity.Results：7583例患者，排水管放置在6666（87.9%）。引流管放置降低了发生严重发病率（相对风险[RR] 0.73，95%置信区间[CI] 0.65-0.82）、总体发病率（RR 0.79，95% CI 0.72-0.87）和器官间隙手术部位感染（RR 0.72，95% CI 0.61-0.85）的风险。引流管放置未改变发生临床相关术后胰瘘的风险（RR 0.96，95% CI 0.78-1.19）。然而，对于放置引流管的患者，引流长度与严重发病率独立相关（风险比[HR] 3.06，95% CI 2.65-3.53），总体发病率（HR 2.48，95% CI 2.202.80）和器官间隙手术部位感染结论：胰管切除术后常规放置引流管可减少术后并发症，包括严重并发症、总并发症和器官间隙感染;然而，引流的长度与上述并发症的风险增加有关。这些结果支持在胰管切除术中常规放置和早期取出引流管。(C)2019爱思唯尔公司All rights reserved.
Background: The decisions to routinely place a drain after pancreaticoduodenectomy and how long to leave the drain remain controversial due to conflicting evidence and significant variations in clinical practice. This study aims to address those questions by using a large national database and a rigorous analytical model.Methods: The American College of Surgeons National Surgical Quality Improvement Program 2015-2016 Pancreatectomy Participant Use Data Files were used to identify patients who had undergone pancreaticoduodenectomy (n = 7583). Univariable and multivariable binomial regression analyses were performed to control for potential confounders and various preoperative risk factors. Cox regression with drain as a time-dependent covariate, conditional on having a drain placed, was used to examine the association between the drain remaining in place and morbidities.Results: Of 7583 patients, drains were placed in 6666 (87.9%). Drain placement decreased the risk of developing serious morbidity (relative risk [RR] 0.73, 95% confidence interval [CI] 0.65-0.82), overall morbidity (RR 0.79, 95% CI 0.72-0.87), and organ space surgical site infection (RR 0.72, 95% CI 0.61-0.85). Drain placement did not change the risk of developing a clinically relevant postoperative pancreatic fistula (RR 0.96, 95% CI 0.78-1.19). However, for those with drains placed, length of drainage was independently associated with serious morbidity (hazard ratio [HR] 3.06, 95% CI 2.65-3.53), overall morbidity (HR 2.48, 95% CI 2.202.80), and organ space surgical site infection (HR 1.47, 95% CI 1.23-1.74).Conclusions: Routine drain placement following pancreaticoduodenectomy may decrease postoperative complications, including serious morbidity, overall morbidity, and organ space surgical site infections; however, length of drainage was associated with increased risk of the previously-named complications. These results support the routine placement and early removal of intraoperative surgical drains in pancreaticoduodenectomy. (C) 2019 Elsevier Inc. All rights reserved.