Variation in Drain Management After Pancreatoduodenectomy: Early Versus Delayed Removal

Joal D. Beane, Michael House, Eugene P. Ceppa, Scott C. Dolejs, Henry A. Pitt

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

OBJECTIVE: The objectives are to report practice patterns and management of operatively placed drains and to compare outcomes in patients with early versus delayed drain removal after pancreatoduodenectomy. BACKGROUND: Early drain removal after pancreatoduodenectomy, when guided by postoperative day (POD) 1 drain fluid amylase (DFA-1), is associated with reduced rates of clinically relevant postoperative pancreatic fistula (CR-POPF). However, whether surgeons have altered their management based on this strategy is unknown. METHODS: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) 2014 Participant Use File was queried to identify patients having undergone pancreatoduodenectomy (n = 3093). Patients with intraoperatively placed drains were stratified according to measurement of DFA-1 and day of drain removal. Patients with POD 1 DFA-1 of ≤5000 U/L whose drains were removed by POD 3 were propensity score-matched with patients whose drains were removed after POD 3. RESULTS: Of 2698 patients, 580 (21.5%) had a DFA-1 recorded. Measurement of DFA-1 was associated with earlier time to drain removal and shorter postoperative length of stay (P < 0.01). Propensity score matching revealed that early drain removal when DFA-1 was ≤5000 U/L was associated with significant (P < 0.05) reductions in overall morbidity (35.3% vs 52.3%), CR-POPF (0.9% vs 7.9%), and length of stay (6 vs 8 days). CONCLUSIONS: Significant variation exists in the use of drain fluid amylase in the management and timing of surgical drain removal after pancreatoduodenectomy. Clinical outcomes are best when drain fluid amylase is low and operatively placed drains are removed by POD 3.

Original languageEnglish (US)
Pages (from-to)718-724
Number of pages7
JournalAnnals of surgery
Volume269
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Pancreaticoduodenectomy
Amylases
Pancreatic Fistula
Propensity Score
Length of Stay
Practice Management
Quality Improvement
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Variation in Drain Management After Pancreatoduodenectomy : Early Versus Delayed Removal. / Beane, Joal D.; House, Michael; Ceppa, Eugene P.; Dolejs, Scott C.; Pitt, Henry A.

In: Annals of surgery, Vol. 269, No. 4, 01.04.2019, p. 718-724.

Research output: Contribution to journalArticle

Beane, Joal D. ; House, Michael ; Ceppa, Eugene P. ; Dolejs, Scott C. ; Pitt, Henry A. / Variation in Drain Management After Pancreatoduodenectomy : Early Versus Delayed Removal. In: Annals of surgery. 2019 ; Vol. 269, No. 4. pp. 718-724.
@article{8ee874fc8e7447718def95f0bf86c83e,
title = "Variation in Drain Management After Pancreatoduodenectomy: Early Versus Delayed Removal",
abstract = "OBJECTIVE: The objectives are to report practice patterns and management of operatively placed drains and to compare outcomes in patients with early versus delayed drain removal after pancreatoduodenectomy. BACKGROUND: Early drain removal after pancreatoduodenectomy, when guided by postoperative day (POD) 1 drain fluid amylase (DFA-1), is associated with reduced rates of clinically relevant postoperative pancreatic fistula (CR-POPF). However, whether surgeons have altered their management based on this strategy is unknown. METHODS: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) 2014 Participant Use File was queried to identify patients having undergone pancreatoduodenectomy (n = 3093). Patients with intraoperatively placed drains were stratified according to measurement of DFA-1 and day of drain removal. Patients with POD 1 DFA-1 of ≤5000 U/L whose drains were removed by POD 3 were propensity score-matched with patients whose drains were removed after POD 3. RESULTS: Of 2698 patients, 580 (21.5{\%}) had a DFA-1 recorded. Measurement of DFA-1 was associated with earlier time to drain removal and shorter postoperative length of stay (P < 0.01). Propensity score matching revealed that early drain removal when DFA-1 was ≤5000 U/L was associated with significant (P < 0.05) reductions in overall morbidity (35.3{\%} vs 52.3{\%}), CR-POPF (0.9{\%} vs 7.9{\%}), and length of stay (6 vs 8 days). CONCLUSIONS: Significant variation exists in the use of drain fluid amylase in the management and timing of surgical drain removal after pancreatoduodenectomy. Clinical outcomes are best when drain fluid amylase is low and operatively placed drains are removed by POD 3.",
author = "Beane, {Joal D.} and Michael House and Ceppa, {Eugene P.} and Dolejs, {Scott C.} and Pitt, {Henry A.}",
year = "2019",
month = "4",
day = "1",
doi = "10.1097/SLA.0000000000002570",
language = "English (US)",
volume = "269",
pages = "718--724",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Variation in Drain Management After Pancreatoduodenectomy

T2 - Early Versus Delayed Removal

AU - Beane, Joal D.

AU - House, Michael

AU - Ceppa, Eugene P.

AU - Dolejs, Scott C.

AU - Pitt, Henry A.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - OBJECTIVE: The objectives are to report practice patterns and management of operatively placed drains and to compare outcomes in patients with early versus delayed drain removal after pancreatoduodenectomy. BACKGROUND: Early drain removal after pancreatoduodenectomy, when guided by postoperative day (POD) 1 drain fluid amylase (DFA-1), is associated with reduced rates of clinically relevant postoperative pancreatic fistula (CR-POPF). However, whether surgeons have altered their management based on this strategy is unknown. METHODS: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) 2014 Participant Use File was queried to identify patients having undergone pancreatoduodenectomy (n = 3093). Patients with intraoperatively placed drains were stratified according to measurement of DFA-1 and day of drain removal. Patients with POD 1 DFA-1 of ≤5000 U/L whose drains were removed by POD 3 were propensity score-matched with patients whose drains were removed after POD 3. RESULTS: Of 2698 patients, 580 (21.5%) had a DFA-1 recorded. Measurement of DFA-1 was associated with earlier time to drain removal and shorter postoperative length of stay (P < 0.01). Propensity score matching revealed that early drain removal when DFA-1 was ≤5000 U/L was associated with significant (P < 0.05) reductions in overall morbidity (35.3% vs 52.3%), CR-POPF (0.9% vs 7.9%), and length of stay (6 vs 8 days). CONCLUSIONS: Significant variation exists in the use of drain fluid amylase in the management and timing of surgical drain removal after pancreatoduodenectomy. Clinical outcomes are best when drain fluid amylase is low and operatively placed drains are removed by POD 3.

AB - OBJECTIVE: The objectives are to report practice patterns and management of operatively placed drains and to compare outcomes in patients with early versus delayed drain removal after pancreatoduodenectomy. BACKGROUND: Early drain removal after pancreatoduodenectomy, when guided by postoperative day (POD) 1 drain fluid amylase (DFA-1), is associated with reduced rates of clinically relevant postoperative pancreatic fistula (CR-POPF). However, whether surgeons have altered their management based on this strategy is unknown. METHODS: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) 2014 Participant Use File was queried to identify patients having undergone pancreatoduodenectomy (n = 3093). Patients with intraoperatively placed drains were stratified according to measurement of DFA-1 and day of drain removal. Patients with POD 1 DFA-1 of ≤5000 U/L whose drains were removed by POD 3 were propensity score-matched with patients whose drains were removed after POD 3. RESULTS: Of 2698 patients, 580 (21.5%) had a DFA-1 recorded. Measurement of DFA-1 was associated with earlier time to drain removal and shorter postoperative length of stay (P < 0.01). Propensity score matching revealed that early drain removal when DFA-1 was ≤5000 U/L was associated with significant (P < 0.05) reductions in overall morbidity (35.3% vs 52.3%), CR-POPF (0.9% vs 7.9%), and length of stay (6 vs 8 days). CONCLUSIONS: Significant variation exists in the use of drain fluid amylase in the management and timing of surgical drain removal after pancreatoduodenectomy. Clinical outcomes are best when drain fluid amylase is low and operatively placed drains are removed by POD 3.

UR - http://www.scopus.com/inward/record.url?scp=85051226132&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85051226132&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000002570

DO - 10.1097/SLA.0000000000002570

M3 - Article

C2 - 29064899

AN - SCOPUS:85051226132

VL - 269

SP - 718

EP - 724

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 4

ER -