• Thomas F Seykora, Jason B Liu, Laura Maggino, Henry A Pitt, and Charles M Vollmer.
• Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
• Ann. Surg. 2020 Dec 1; 272 (6): 1110-1117.

ObjectiveTo explore contemporary drain management practices and examine the impact of early removal following distal pancreatectomy (DP).BackgroundDespite accruing evidence supporting its benefit following pancreatoduodenectomy, early drain removal after DP has yet to be explored.MethodsThe American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) was queried for elective DPs from 2014 to 2017. When possible, data were linked to survey responses regarding drain management from hepato-pancreato-biliary (HPB) surgeons in the ACS-NSQIP HPB Collaborative conducted in 2017. The independent association between timing of drain removal and patients' outcomes was investigated through multivariable analyses and propensity-score matching.ResultsOf 5581 DPs identified, 4708 (84.4%) patients received intraoperative drains and early removal (≤ POD3) was performed in 716 (15.2%). Drain fluid amylase was recorded on POD1 for 1285 (27.3%) patients who received drains. The overall rates of death or serious morbidity (DSM) and clinically-relevant fistula (CR-POPF) were 19.5% and 17.0%. Early removal demonstrated significantly better outcomes when compared to late removal and no drain placement for: DSM, CR-POPF, delayed gastric emptying, percutaneous drainage, length of stay, and readmission. On multivariable analysis, early removal demonstrated reduced odds of developing DSM (OR = 0.41, 95% CI = 0.26-0.65) and CR-POPF (OR = 0.33, 95% CI = 0.18-0.61) compared to no drain placement, while late removal displayed increased odds for CR-POPF (OR = 2.15, 95% CI = 1.27-3.61) when compared to no drain placement. After propensity-score matching, early removal was associated with reduced odds for CR-POPF (OR = 0.35, 95% CI = 0.17-0.73).ConclusionAlthough not yet widely implemented, early drain removal after distal pancreatectomy is associated with better outcomes. This study demonstrates the potential benefits of early removal and provides a substrate to define best practices and improve the quality of care for DP.

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