Background

Recent data suggest that routine drainage is unnecessary in patients undergoing hepatectomy, but many surgeons continue to utilize drains. We compared the outcomes of patients undergoing early versus routine drain removal after hepatectomy.

Methods

Patients having drains placed during major (≥3 segments) or partial hepatectomy (≤2 segments) were identified in the 2014-16 ACS-NSQIP database. Propensity matching between early (POD 0–3) and routine (POD 4–7) drain removal and multivariable regressions were performed.

Results

Early drain removal was performed in 661 (40%) of patients undergoing a partial hepatectomy and 211 (22%) of major hepatectomy patients. After matching, 719 early and 719 routine drain removal patients were compared. Early drain removal patients had lower overall (12 vs 19%, p < 0.001) and serious (9 vs 13%, p < 0.03) morbidity as well as fewer bile leaks (2.1% vs 5.0%, p < 0.003). Length of stay was two days shorter (4 vs 6 days, p < 0.01) and readmissions were less frequent (5.4 vs 8.1%, p = 0.02) for patients undergoing early drain removal.

Conclusion

Early drain removal is associated with fewer overall and serious complications, shorter length of stay and fewer readmissions. Early drain removal after hepatectomy is an underutilized management strategy.

中文翻译：

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肝切除术后早期引流管切除：未充分利用的管理策略

背景

最近的数据表明，接受肝切除术的患者不需要常规引流，但许多外科医生继续使用引流。我们比较了肝切除术后接受早期和常规引流管切除的患者的结果。

方法

在 2014-16 ACS-NSQIP 数据库中确定了在主要（≥3 段）或部分肝切除术（≤2 段）期间放置引流管的患者。进行了早期（POD 0-3）和常规（POD 4-7）排水管移除和多变量回归之间的倾向匹配。

结果

661 名 (40%) 接受部分肝切除术的患者和 211 名 (22%) 大肝切除术患者进行了早期引流管切除。匹配后，对 719 例早期和 719 例常规引流管拔除患者进行了比较。早期引流管切除患者的总体发病率较低（12% vs 19%，p < 0.001）和严重（9 vs 13%，p < 0.03）发病率以及胆漏较少（2.1% vs 5.0%，p < 0.003）。对于接受早期引流管移除的患者，住院时间缩短了两天（4 天对 6 天，p < 0.01），再入院率降低（5.4 对 8.1%，p = 0.02）。

结论

早期引流管移除与更少的整体和严重并发症、更短的住院时间和更少的再入院相关。肝切除术后早期去除引流是一种未充分利用的管理策略。