A risk-adjusted analysis of drain use in pancreaticoduodenectomy: some is good, but more may not be better
نویسندگان
چکیده
Presenter: Lisa Brubaker MD | Baylor College of Medicine Background: Intraperitoneal drain placement is presumed to decrease morbidity and mortality in patients who develop a clinically relevant post-operative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD). It unknown whether multiple drains mitigate CR-POPF better than single drain. We hypothesize that the complication burden more drain, particularly cases at greater risk for CR-POPF. Methods: The Fistula Risk Score (FRS), mitigation strategies (including number placed), clinical outcomes were obtained from multi-institutional database PDs performed 2003-2020. Outcomes compared between receiving 0, 1, or 2 intraperitoneal drains. A risk-adjusted multivariable regression analysis was used evaluate optimal drainage approach. Results: total 4292 utilized 0 (7.3%), 1 (45.2%), (47.5%) with an observed overall rate 9.6%, which higher intermediate/high FRS zone (FRS 3-10) negligible/low 0-2) (13% vs. 2.4%, p<0.001). placed correlated (median cases). Obviation associated increases regardless (mortality 3% 1.1% 0.4%, p = 0.017 14.4% 2.0% 2.1%, p<0.001 drains, respectively), as well significant (Figure 1). In contrast, use instead had comparable rates mortality, CR-POPF, average attributed reoperations Further, logistic model accounting patient factors, operative details, alternative risk-reducing strategies, lower incidence (OR 0.59, 95% CI 0.415-0.839, 0.003) cases. Conclusion: For pancreaticoduodenectomy, omission inferior outcomes. cases, appears frequency just perhaps even better.
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ژورنال
عنوان ژورنال: Hpb
سال: 2021
ISSN: ['1365-182X', '1477-2574']
DOI: https://doi.org/10.1016/j.hpb.2021.06.075