Abstract
Abstract Background: Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, Enhanced Recovery After Surgery (ERAS) guidelines recommend against their routine use due to a lack of clear clinical benefit. This study aims to describe international variation in intraperitoneal drain placement and the safety of this practice.
Methods: COMPlicAted intra-abdominal collectionS after colorectal Surgery (COMPASS) was a prospective, international, cohort study which enrolled consecutive adult patients undergoing elective colorectal surgery (February-March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time-to-diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time-to-discharge; 30‐day major postoperative complications (Clavien–Dindo grade ≥3). After propensity-score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement.
Results: Overall, 1805 patients from 22 countries were included (798 [44.2%] female; median age 67.0 years). The drain insertion rate was 51.9% (n=937). After matching, drains were not associated with reduced rates (OR 1.33, 95% CI: 0.79-2.23, p=0.287) or earlier detection of collections (HR 0.87, 95% CI: 0.33-2.31, p=0.780). Although not associated with worse major postoperative complications (OR 1.09, 95% CI: 0.68-1.75, p=0.709), drains were associated with delayed hospital discharge (HR 0.58, 95% CI: 0.52-0.66, p<0.001) and increased risk of SSIs (OR 2.47, 95% CI: 1.50-4.05, p<0.001).
Conclusion: Intraperitoneal drain placement after elective colorectal surgery does not detect postoperative collections earlier, but does prolong length of stay and increase SSI risk.
Methods: COMPlicAted intra-abdominal collectionS after colorectal Surgery (COMPASS) was a prospective, international, cohort study which enrolled consecutive adult patients undergoing elective colorectal surgery (February-March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time-to-diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time-to-discharge; 30‐day major postoperative complications (Clavien–Dindo grade ≥3). After propensity-score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement.
Results: Overall, 1805 patients from 22 countries were included (798 [44.2%] female; median age 67.0 years). The drain insertion rate was 51.9% (n=937). After matching, drains were not associated with reduced rates (OR 1.33, 95% CI: 0.79-2.23, p=0.287) or earlier detection of collections (HR 0.87, 95% CI: 0.33-2.31, p=0.780). Although not associated with worse major postoperative complications (OR 1.09, 95% CI: 0.68-1.75, p=0.709), drains were associated with delayed hospital discharge (HR 0.58, 95% CI: 0.52-0.66, p<0.001) and increased risk of SSIs (OR 2.47, 95% CI: 1.50-4.05, p<0.001).
Conclusion: Intraperitoneal drain placement after elective colorectal surgery does not detect postoperative collections earlier, but does prolong length of stay and increase SSI risk.
| Original language | English |
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| Journal | British Journal of Surgery |
| DOIs | |
| Publication status | Published - 30 Mar 2022 |