Background

Prophylactic drainage following hepatectomy is frequently performed despite evidence that drainage is unnecessary. It is unknown to what extent drain use is influenced by hospital practice patterns. The objectives of this study were to identify factors associated with the use of prophylactic drains following hepatectomy and assess hospital variation in drain use.

Methods

Retrospective cohort study of patients following hepatectomy without concomitant bowel resection or biliary reconstruction from the ACS NSQIP Hepatectomy Targeted Dataset. Factors associated with the use of prophylactic drains were identified using multivariable logistic regression and hospital-level variation in drain use was assessed.

Results

Analysis included 10,530 patients at 130 hospitals. Overall, 42.3% of patients had a prophylactic drain placed following hepatectomy. Patients were more likely to receive prophylactic drains if they were ≥65 years old (adjusted odds ratio [aOR]: 1.34, 95%CI: 1.16–1.56), underwent major hepatectomy (aOR: 1.42, 95%CI 1.15–1.74), or had an open resection (aOR 1.94, 95%CI 1.49–2.53). There was notable hospital variability in drain use (range: 0%–100% of patients), and 77.5% of measured variation was at the hospital level.

Conclusion

Prophylactic drains are commonly placed in both major and minor hepatectomy. Hospital-specific patterns appear to be a major driver and represent a target for improvement.

中文翻译：

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肝切除术后预防性引流管使用的医院差异

背景

尽管有证据表明不需要引流，但仍经常在肝切除术后进行预防性引流。目前尚不清楚医院实践模式对引流管使用的影响程度。本研究的目的是确定与肝切除术后使用预防性引流管相关的因素，并评估引流管使用的医院差异。

方法

来自 ACS NSQIP 肝切除术靶向数据集的肝切除术后患者的回顾性队列研究，未同时进行肠切除或胆道重建。使用多变量逻辑回归确定了与使用预防性引流管相关的因素，并评估了引流管使用的医院级别变化。

结果

分析包括 130 家医院的 10,530 名患者。总体而言，42.3% 的患者在肝切除术后放置了预防性引流管。如果患者年龄≥65 岁（调整比值比 [aOR]：1.34，95%CI：1.16-1.56），接受过大肝切除术（aOR：1.42，95%CI 1.15-1.74），患者更有可能接受预防性引流，或进行了开放性切除术（aOR 1.94，95% CI 1.49–2.53）。引流管使用存在显着的医院变异性（范围：0%–100% 的患者），并且 77.5% 的测量变异发生在医院层面。

结论

预防性引流管通常放置在主要和次要肝切除术中。医院特定的模式似乎是一个主要驱动因素，代表了改进的目标。