Premium
Clinical impact of the sequentially‐checked drain removal criteria on postoperative outcomes after pancreatectomy: a retrospective study
Author(s) -
Kosaka Hisashi,
Satoi Sohei,
Yamamoto Tomohisa,
Hirooka Satoshi,
Yamaki So,
Kotsuka Masaya,
Sakaguchi Tatsuma,
Inoue Kentaro,
Matsui Yoichi,
Sekimoto Mitsugu
Publication year - 2019
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.649
Subject(s) - medicine , odds ratio , distal pancreatectomy , confidence interval , pancreatectomy , pancreatic fistula , surgery , retrospective cohort study , gastroenterology , pancreas , resection
Background Strict criteria for impeccably safe drain management following pancreatectomy have not yet been developed. We evaluated the utility of the sequentially‐checked drain removal criteria by comparison with conventional criteria. Methods Postoperative outcomes of 801 patients who underwent pancreatectomy, including 395 patients for whom drain fluid amylase (DFA) < 375U/l on postoperative day (POD) 3 (control group), were used and 406 patients for whom the sequentially‐checked criteria of DFA <5,000 U/l on POD 1 and DFA <3,000 U/l on POD 3 (sequentially‐checked group) were used and were retrospectively evaluated. Results DFA on POD 3 and fistula risk score did not differ between groups. Significantly more patients in the sequentially‐checked group met the criteria (control, 63.8% vs. sequentially‐checked, 76.1%, P < 0.001). The incidences of clinically relevant postoperative pancreatic fistula (CR‐POPF) (17.0% vs. 11.1%), intra‐abdominal abscess (21.0% vs. 9.1%) were significantly lower in the sequentially‐checked group (all P < 0.05). Multivariate analysis revealed that use of the sequentially‐checked criteria was significantly associated with CR‐POPF (odds ratio 0.601, 95% confidence interval [CI] 0.389–0.929; P = 0.022). C‐reactive protein <15 mg/dl at POD 3 was identified as an independent predictive factor for false positive CR‐POPF results in the sequentially‐checked group (odds ratio 0.872, 95% CI 0.811–0.939; P < 0.001); thus, this criterion was added to create the new triple‐checked criteria. Conclusions The sequentially‐checked criteria can provide safe drain management and improve postoperative outcomes.