Evidence versus Practice in Early Drain Removal After Pancreatectomy

Nicole Villafane-Ferriol, Katherine A. Baugh, Amy L. McElhany, George Van Buren, Andrew Fang, Erisha K. Tashakori, Jose E.Mendez Reyes, Hop S.Tran Cao, Eric J. Silberfein, Nader Massarweh, Cary Hsu, Omar Barakat, Carl Schmidt, Nicholas Zyromski, Mary Dillhoff, Joshua A. Villarreal, William E. Fisher

Research output: Contribution to journalArticle

Abstract

Background: Early drain removal when postoperative day (POD) one drain fluid amylase (DFA) was ≤5000 U/L reduced complications in a previous randomized controlled trial. We hypothesized that most surgeons continue to remove drains late and this is associated with inferior outcomes. Methods: We assessed the practice of surgeons in a prospectively maintained pancreas surgery registry to determine the association between timing of drain removal with demographics, comorbidities, and complications. We selected patients with POD1 DFA ≤5000 U/L and excluded those without drains, and subjects without data on POD1 DFA or timing of drain removal. Early drain removal was defined as ≤ POD5. Results: Two hundred and forty four patients met inclusion criteria. Only 90 (37%) had drains removed early. Estimated blood loss was greater in the late removal group (190 mL versus 100 mL, P = 0.005) and pathological findings associated with soft gland texture were more frequent (97 [63%] versus 35 [39%], P < 0.0001). Patients in the late drain removal group had more complications (84 [55%] versus 30 [33%], P = 0.001) including pancreatic fistula (55 [36%] versus 4 [4%], P < 0.0001), delayed gastric emptying (27 [18%] versus 3 [3%], P = 0.002), and longer length of stay (7 d versus 5 d, P < 0.0001). In subset analysis for procedure type, complications and pancreatic fistula remained significant for both pancreatoduodenectomy and distal pancreatectomy. Conclusions: Despite level one data suggesting improved outcomes with early removal when POD1 DFA is ≤ 5000 U/L, experienced pancreas surgeons more frequently removed drains late. This practice was associated with known risk factors (estimated blood loss, soft pancreas) and may be associated with inferior outcomes suggesting potential for improvement.

Original languageEnglish (US)
Pages (from-to)332-339
Number of pages8
JournalJournal of Surgical Research
Volume236
DOIs
StatePublished - Apr 1 2019

Fingerprint

Pancreatectomy
Amylases
Pancreatic Fistula
Pancreas
Pancreaticoduodenectomy
Gastric Emptying
Registries
Comorbidity
Length of Stay
Randomized Controlled Trials
Demography
Surgeons

Keywords

  • Amylase
  • Distal pancreatectomy
  • Early drain removal
  • Pancreatoduodenectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Villafane-Ferriol, N., Baugh, K. A., McElhany, A. L., Van Buren, G., Fang, A., Tashakori, E. K., ... Fisher, W. E. (2019). Evidence versus Practice in Early Drain Removal After Pancreatectomy. Journal of Surgical Research, 236, 332-339. https://doi.org/10.1016/j.jss.2018.11.048

Evidence versus Practice in Early Drain Removal After Pancreatectomy. / Villafane-Ferriol, Nicole; Baugh, Katherine A.; McElhany, Amy L.; Van Buren, George; Fang, Andrew; Tashakori, Erisha K.; Reyes, Jose E.Mendez; Cao, Hop S.Tran; Silberfein, Eric J.; Massarweh, Nader; Hsu, Cary; Barakat, Omar; Schmidt, Carl; Zyromski, Nicholas; Dillhoff, Mary; Villarreal, Joshua A.; Fisher, William E.

In: Journal of Surgical Research, Vol. 236, 01.04.2019, p. 332-339.

Research output: Contribution to journalArticle

Villafane-Ferriol, N, Baugh, KA, McElhany, AL, Van Buren, G, Fang, A, Tashakori, EK, Reyes, JEM, Cao, HST, Silberfein, EJ, Massarweh, N, Hsu, C, Barakat, O, Schmidt, C, Zyromski, N, Dillhoff, M, Villarreal, JA & Fisher, WE 2019, 'Evidence versus Practice in Early Drain Removal After Pancreatectomy', Journal of Surgical Research, vol. 236, pp. 332-339. https://doi.org/10.1016/j.jss.2018.11.048
Villafane-Ferriol N, Baugh KA, McElhany AL, Van Buren G, Fang A, Tashakori EK et al. Evidence versus Practice in Early Drain Removal After Pancreatectomy. Journal of Surgical Research. 2019 Apr 1;236:332-339. https://doi.org/10.1016/j.jss.2018.11.048
Villafane-Ferriol, Nicole ; Baugh, Katherine A. ; McElhany, Amy L. ; Van Buren, George ; Fang, Andrew ; Tashakori, Erisha K. ; Reyes, Jose E.Mendez ; Cao, Hop S.Tran ; Silberfein, Eric J. ; Massarweh, Nader ; Hsu, Cary ; Barakat, Omar ; Schmidt, Carl ; Zyromski, Nicholas ; Dillhoff, Mary ; Villarreal, Joshua A. ; Fisher, William E. / Evidence versus Practice in Early Drain Removal After Pancreatectomy. In: Journal of Surgical Research. 2019 ; Vol. 236. pp. 332-339.
@article{71fca7a937174d7a88d058171dd770a7,
title = "Evidence versus Practice in Early Drain Removal After Pancreatectomy",
abstract = "Background: Early drain removal when postoperative day (POD) one drain fluid amylase (DFA) was ≤5000 U/L reduced complications in a previous randomized controlled trial. We hypothesized that most surgeons continue to remove drains late and this is associated with inferior outcomes. Methods: We assessed the practice of surgeons in a prospectively maintained pancreas surgery registry to determine the association between timing of drain removal with demographics, comorbidities, and complications. We selected patients with POD1 DFA ≤5000 U/L and excluded those without drains, and subjects without data on POD1 DFA or timing of drain removal. Early drain removal was defined as ≤ POD5. Results: Two hundred and forty four patients met inclusion criteria. Only 90 (37{\%}) had drains removed early. Estimated blood loss was greater in the late removal group (190 mL versus 100 mL, P = 0.005) and pathological findings associated with soft gland texture were more frequent (97 [63{\%}] versus 35 [39{\%}], P < 0.0001). Patients in the late drain removal group had more complications (84 [55{\%}] versus 30 [33{\%}], P = 0.001) including pancreatic fistula (55 [36{\%}] versus 4 [4{\%}], P < 0.0001), delayed gastric emptying (27 [18{\%}] versus 3 [3{\%}], P = 0.002), and longer length of stay (7 d versus 5 d, P < 0.0001). In subset analysis for procedure type, complications and pancreatic fistula remained significant for both pancreatoduodenectomy and distal pancreatectomy. Conclusions: Despite level one data suggesting improved outcomes with early removal when POD1 DFA is ≤ 5000 U/L, experienced pancreas surgeons more frequently removed drains late. This practice was associated with known risk factors (estimated blood loss, soft pancreas) and may be associated with inferior outcomes suggesting potential for improvement.",
keywords = "Amylase, Distal pancreatectomy, Early drain removal, Pancreatoduodenectomy",
author = "Nicole Villafane-Ferriol and Baugh, {Katherine A.} and McElhany, {Amy L.} and {Van Buren}, George and Andrew Fang and Tashakori, {Erisha K.} and Reyes, {Jose E.Mendez} and Cao, {Hop S.Tran} and Silberfein, {Eric J.} and Nader Massarweh and Cary Hsu and Omar Barakat and Carl Schmidt and Nicholas Zyromski and Mary Dillhoff and Villarreal, {Joshua A.} and Fisher, {William E.}",
year = "2019",
month = "4",
day = "1",
doi = "10.1016/j.jss.2018.11.048",
language = "English (US)",
volume = "236",
pages = "332--339",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Evidence versus Practice in Early Drain Removal After Pancreatectomy

AU - Villafane-Ferriol, Nicole

AU - Baugh, Katherine A.

AU - McElhany, Amy L.

AU - Van Buren, George

AU - Fang, Andrew

AU - Tashakori, Erisha K.

AU - Reyes, Jose E.Mendez

AU - Cao, Hop S.Tran

AU - Silberfein, Eric J.

AU - Massarweh, Nader

AU - Hsu, Cary

AU - Barakat, Omar

AU - Schmidt, Carl

AU - Zyromski, Nicholas

AU - Dillhoff, Mary

AU - Villarreal, Joshua A.

AU - Fisher, William E.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: Early drain removal when postoperative day (POD) one drain fluid amylase (DFA) was ≤5000 U/L reduced complications in a previous randomized controlled trial. We hypothesized that most surgeons continue to remove drains late and this is associated with inferior outcomes. Methods: We assessed the practice of surgeons in a prospectively maintained pancreas surgery registry to determine the association between timing of drain removal with demographics, comorbidities, and complications. We selected patients with POD1 DFA ≤5000 U/L and excluded those without drains, and subjects without data on POD1 DFA or timing of drain removal. Early drain removal was defined as ≤ POD5. Results: Two hundred and forty four patients met inclusion criteria. Only 90 (37%) had drains removed early. Estimated blood loss was greater in the late removal group (190 mL versus 100 mL, P = 0.005) and pathological findings associated with soft gland texture were more frequent (97 [63%] versus 35 [39%], P < 0.0001). Patients in the late drain removal group had more complications (84 [55%] versus 30 [33%], P = 0.001) including pancreatic fistula (55 [36%] versus 4 [4%], P < 0.0001), delayed gastric emptying (27 [18%] versus 3 [3%], P = 0.002), and longer length of stay (7 d versus 5 d, P < 0.0001). In subset analysis for procedure type, complications and pancreatic fistula remained significant for both pancreatoduodenectomy and distal pancreatectomy. Conclusions: Despite level one data suggesting improved outcomes with early removal when POD1 DFA is ≤ 5000 U/L, experienced pancreas surgeons more frequently removed drains late. This practice was associated with known risk factors (estimated blood loss, soft pancreas) and may be associated with inferior outcomes suggesting potential for improvement.

AB - Background: Early drain removal when postoperative day (POD) one drain fluid amylase (DFA) was ≤5000 U/L reduced complications in a previous randomized controlled trial. We hypothesized that most surgeons continue to remove drains late and this is associated with inferior outcomes. Methods: We assessed the practice of surgeons in a prospectively maintained pancreas surgery registry to determine the association between timing of drain removal with demographics, comorbidities, and complications. We selected patients with POD1 DFA ≤5000 U/L and excluded those without drains, and subjects without data on POD1 DFA or timing of drain removal. Early drain removal was defined as ≤ POD5. Results: Two hundred and forty four patients met inclusion criteria. Only 90 (37%) had drains removed early. Estimated blood loss was greater in the late removal group (190 mL versus 100 mL, P = 0.005) and pathological findings associated with soft gland texture were more frequent (97 [63%] versus 35 [39%], P < 0.0001). Patients in the late drain removal group had more complications (84 [55%] versus 30 [33%], P = 0.001) including pancreatic fistula (55 [36%] versus 4 [4%], P < 0.0001), delayed gastric emptying (27 [18%] versus 3 [3%], P = 0.002), and longer length of stay (7 d versus 5 d, P < 0.0001). In subset analysis for procedure type, complications and pancreatic fistula remained significant for both pancreatoduodenectomy and distal pancreatectomy. Conclusions: Despite level one data suggesting improved outcomes with early removal when POD1 DFA is ≤ 5000 U/L, experienced pancreas surgeons more frequently removed drains late. This practice was associated with known risk factors (estimated blood loss, soft pancreas) and may be associated with inferior outcomes suggesting potential for improvement.

KW - Amylase

KW - Distal pancreatectomy

KW - Early drain removal

KW - Pancreatoduodenectomy

UR - http://www.scopus.com/inward/record.url?scp=85059351716&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059351716&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2018.11.048

DO - 10.1016/j.jss.2018.11.048

M3 - Article

VL - 236

SP - 332

EP - 339

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

ER -