Drain placement after pancreatic resection: friend or foe for surgical site infections?

Authors

Tommaso Pollini, Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, USA.
Paul Wong, Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, USA.
Lyonell B. Kone, Advocate Aurora HealthFollow
Rym El Khoury, Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, USA.
Chris Kabir, Advocate Aurora HealthFollow
Vijay K. Maker, Advocate Aurora HealthFollow
Mihaela Banulescu, Advocate Aurora HealthFollow
Ajay V. Maker, Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, USA. ajay.maker@ucsf.edu.

Recommended Citation

Pollini T, Wong P, Kone LB, et al. Drain Placement After Pancreatic Resection: Friend or Foe For Surgical Site Infections?. J Gastrointest Surg. 2023;27(4):724-729. doi:10.1007/s11605-023-05612-0

Affiliations

Creticos Cancer Center, Advocate Illinois Masonic Medical Center

Abstract

Background: Despite multiple studies and randomized trials, there remains controversy over whether drains should be placed, and if so for how long, after pancreas resection. The aim was to determine if post-pancreatectomy drain placement and timing of drain removal were associated with differences in infectious outcomes and, if so, which specific procedures and infectious sites were most at risk.

Methods: The ACS-NSQIP targeted pancreatectomy database was utilized to identify patients who underwent pancreatectomies between 2015 and 2020 with postoperative drain placement for retrospective cohort analysis. A propensity score matching analyses was conducted to determine associations between drain placement and surgical site infections (SSI).

Results: Of 39,057 pancreatic resections, 66.4% were proximal pancreatectomies, and 33.6% were distal pancreatectomies. After propensity score matching, drain placement was not associated with significantly lower rates of superficial SSI (7% vs 9%, p = 0.755) or organ/space SSI (17% vs 16%, p = 0.647) after proximal pancreatectomy. After distal pancreatectomy, drain placement was associated with higher rates of organ/space SSI (12% vs 9%, p = 0.010). Drain removal on or after postoperative day 3 was significantly associated with higher rates of SSI in both proximal and distal pancreatectomy.

Conclusions: Drain placement is associated with an increased rate of organ/space SSI after distal pancreatectomy and not after pancreaticoduodenectomy. When drains are utilized, early removal is associated with a reduction of SSI after all types of pancreatectomy. In surgical units where post-pancreatectomy SSI is a concern, selective drain placement for high-risk glands or after distal pancreatectomy, combined with early drain removal, may be considered.

Document Type

Article

PubMed ID

36737592