Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

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Karmally, Z; Mcteir, K; Hanna, M; Tan, E; Namdeo, S; Schembri, R; Pusey, E

doi:10.1093/bjs/znac069

Background:Manysurgeonsroutinelyplaceintraperitonealdrainsafterelectivecolorectalsurgery.However,enhancedrecoveryafter surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods:COMPASS(COMPlicAtedintra-abdominalcollectionSaftercolorectalSurgery)wasaprospective,international,cohortstudy whichenrolledconsecutiveadultsundergoingelectivecolorectalsurgery(FebruarytoMarch2020).Theprimaryoutcomewastherate 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; and 30-day major postoperative complications (Clavien–Dindo grade at least III). 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 (798women,44.2 percent;medianage67.0years).Thedraininsertion rate was51.9percent(937patients).Aftermatching,drainswerenotassociatedwithreducedrates(oddsratio(OR)1.33,95percentc.i. 0.79 to 2.23; P=0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P=0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P=0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P,0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P,0.001). Conclusion: Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk.

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[10.1093/bjs/znac069]