دورية أكاديمية
Value of primary operative drain placement after major hepatectomy: a multi-institutional analysis of 1,041 patients.
| العنوان: | Value of primary operative drain placement after major hepatectomy: a multi-institutional analysis of 1,041 patients. |
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| المؤلفون: | Squires MH 3rd; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA., Lad NL; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA., Fisher SB; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA., Kooby DA; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA., Weber SM; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI., Brinkman A; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI., Sarmiento JM; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA., Scoggins CR; Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY., Egger ME; Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY., Cardona K; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA., Cho CS; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI., Martin RC; Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY., Russell MC; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA., Winslow E; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI., Staley CA 3rd; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA., Maithel SK; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA. Electronic address: smaithe@emory.edu. |
| المصدر: | Journal of the American College of Surgeons [J Am Coll Surg] 2015 Apr; Vol. 220 (4), pp. 396-402. Date of Electronic Publication: 2015 Jan 02. |
| نوع المنشور: | Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins, Inc Country of Publication: United States NLM ID: 9431305 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-1190 (Electronic) Linking ISSN: 10727515 NLM ISO Abbreviation: J Am Coll Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2022- : [Baltimore, MD] : Lippincott Williams & Wilkins, Inc. Original Publication: Chicago, Ill. : The College, c1994- |
| مواضيع طبية MeSH: | Drainage/*instrumentation , Hepatectomy/*methods , Postoperative Care/*methods , Postoperative Complications/*surgery , Risk Assessment/*methods, Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Patient Readmission/trends ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies ; Treatment Outcome ; United States/epidemiology |
| مستخلص: | Background: The value of routine primary (intraoperative) drain placement after major hepatectomy remains unclear. We sought to determine if primary drainage led to decreased rates of complications, specifically, intra-abdominal biloma or infection requiring a secondary (postoperative) drainage procedure. Study Design: All patients who underwent major hepatectomy (≥3 hepatic segments) at 3 institutions, from 2000 to 2012, were identified. Patients with biliary anastomoses were excluded. Primary outcomes were any complication, rate of secondary drainage procedures, bile leak, and 30-day readmission. Results: There were 1,041 patients who underwent major hepatectomy without biliary anastomosis; 564 (54%) had primary drains placed at the surgeon's discretion. Primary drain placement was associated with increased complications (56% vs 44%; p < 0.001), bile leaks (7.3% vs 4.2%; p = 0.048), and 30-day readmissions (16.4% vs 8.0%; p < 0.001), but was not associated with a decrease in secondary drainage procedures (8.0% vs 5.9%; p = 0.23). Patients with primary drains demonstrated higher American Society of Anesthesioloigsts (ASA) class, greater blood loss, more transfusions, and larger resections. After accounting for these significant clinicopathologic variables on multivariate analysis, primary drain placement was not associated with increased risk of any complications. Primary drainage was, however, independently associated with increased risk of bile leak (hazard ratio [HR] 2.04; 95% CI1.02 to 4.09; p = 0.044) and 30-day readmission (HR 1.79; 95% CI1.14 to 2.80; p = 0.011). There still was no reduction in the need for secondary drainage procedures (HR 0.98; p = 0.96). Conclusions: Primary intraoperative drain placement after major hepatectomy does not decrease the need for secondary drainage procedures and may be associated with increased bile leaks and 30-day readmissions. Routine drain placement is not warranted. (Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.) |
| التعليقات: | Comment in: J Am Coll Surg. 2015 Apr;220(4):402-4. (PMID: 25797722) |
| تواريخ الأحداث: | Date Created: 20150301 Date Completed: 20150526 Latest Revision: 20210402 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1016/j.jamcollsurg.2014.12.029 |
| PMID: | 25724607 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1879-1190 |
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| DOI: | 10.1016/j.jamcollsurg.2014.12.029 |