Early Removal of Prophylactic Drains Reduces the Risk of Intra-abdominal Infections in Patients with Pancreatic Head Resection: Prospective Study for 104 Consecutive Patients.
From: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
Annals of surgery
- Publish Date: Jul 2006
- ISSN: 0003-4932
- Volume: 244
- Issue: 1
- Pages: 1-7
- Medium: Print
- Language: English
- Citation (JAMA): Kawai Manabu, Tani Masaji, Terasawa Hiroshi, et al. Early Removal of Prophylactic Drains Reduces the Risk of Intra-abdominal Infections in Patients with Pancreatic Head Resection: Prospective Study for 104 Consecutive Patients.. Ann. Surg. Jul 2006;244:1-7
Abstract
OBJECTIVE: The aim of this study was designed to determine whether the period of drain insertion influences the incidence of postoperative complications. BACKGROUND DATA: The significance of prophylactic drains after pancreatic head resection is still controversial. No report discusses the association of the period of drain insertion and postoperative complications. METHODS: A total of 104 consecutive patients who underwent pancreatic head resection were enrolled in this study. To assess the value of prophylactic drains, we prospectively assigned the patients into 2 groups: group I underwent resection from January 2000 to January 2002 (n = 52, drain to be removed on postoperative day 8); group II underwent resection from February 2002 to December 2004 (n = 52, drain to be removed on postoperative day 4). Postoperative complications in the 2 groups were compared. RESULTS: The rate of pancreatic fistula was significantly lower in group II (3.6%) than in group I (23%) (P = 0.0038). The rate of intra-abdominal infections, including intra-abdominal abscess and infected intra-abdominal collections, was significantly reduced in group II (7.7%) compared with group I (38%) (P = 0.0003). Eighteen of 52 (34.6%) patients in group I had an inserted drain beyond 8 days, whereas only 2 of 52 (3.7%) patients in group II had an inserted drain beyond 4 days (P = 0.0002). Cultures of drainage fluid were positive in 16 of 52 (30.8%) patients in group I, and in 2 of 52 (3.7%) patients in group II (P = 0.0002). Intraoperative bleeding (> 1500 mL), operative time (> 420 minutes, and the period of drain insertion were significant risk factors for intra-abdominal infections (P = 0.043, 0.025, 0.0003, respectively). The period of drain insertion was the only independent risk factor for intra-abdominal infections by multivariate analysis (odds ratio, 6.7). CONCLUSION: Drain removal on postoperative day 4 was shown to be an independent factor in reducing the incidence of complications with pancreatic head resection, including intra-abdominal infections.
Mesh Headings (Keywords): Abdomen, Abdominal Abscess, Aged, Amylases, Bacterial Infections, C-Reactive Protein, Device Removal, Drainage, Female, Humans, Leukocyte Count, Male, Pancreatic Fistula, Pancreaticoduodenectomy, Postoperative Care, Postoperative Complications, Risk Factors, Time Factors
Check for Full Text / PubMed Unique Identifier (PMID): 16794381
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