Value of primary operative drain placement after major hepatectomy: a multi-institutional analysis of 1,041 patients.

Journal of the American College of Surgeons
Malcolm H SquiresShishir K Maithel

Abstract

The value of routine primary (intraoperative) drain placement after major hepatectomy remains unclear. We sought to determine if primary drainage led to decreased rates of complications, specifically, intra-abdominal biloma or infection requiring a secondary (postoperative) drainage procedure. All patients who underwent major hepatectomy (≥3 hepatic segments) at 3 institutions, from 2000 to 2012, were identified. Patients with biliary anastomoses were excluded. Primary outcomes were any complication, rate of secondary drainage procedures, bile leak, and 30-day readmission. There were 1,041 patients who underwent major hepatectomy without biliary anastomosis; 564 (54%) had primary drains placed at the surgeon's discretion. Primary drain placement was associated with increased complications (56% vs 44%; p < 0.001), bile leaks (7.3% vs 4.2%; p = 0.048), and 30-day readmissions (16.4% vs 8.0%; p < 0.001), but was not associated with a decrease in secondary drainage procedures (8.0% vs 5.9%; p = 0.23). Patients with primary drains demonstrated higher American Society of Anesthesioloigsts (ASA) class, greater blood loss, more transfusions, and larger resections. After accounting for these significant clinicopathologic variables on mu...Continue Reading

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Citations

Jun 11, 2015·World Journal of Surgery·Isidoro Di CarloGaetano Bertino
Aug 3, 2016·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Guido TorzilliJean-Nicolas Vauthey
Oct 16, 2016·World Journal of Surgery·Chaya ShwaartzCelia M Divino
Jan 25, 2017·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Daisuke HokutoHiromichi Kanehiro
Nov 14, 2017·The British Journal of Surgery·K MohkamUNKNOWN Association de Chirurgie Hépato-Biliaire et de Transplantation (ACHBT) French Hepatectomy Study Group
May 28, 2020·Annals of Hepato-biliary-pancreatic Surgery·Andrew K Y FungPaul B S Lai
Dec 6, 2018·Canadian Journal of Gastroenterology & Hepatology·Mohammad GolrizArianeb Mehrabi
Apr 29, 2020·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Kota SaharaTimothy M Pawlik
Mar 17, 2020·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Ryan J EllisRyan P Merkow
Mar 30, 2020·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Alexander M FagensonHenry A Pitt

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