Abdominal Drainage

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Kimberly A Bertens - One of the best experts on this subject based on the ideXlab platform.

  • passive versus active intra Abdominal Drainage following pancreaticoduodenectomy a retrospective study using the american college of surgeons nsqip database
    World Journal of Surgery, 2021
    Co-Authors: Madeline Lemke, Lily Park, Fady Balaa, Guillaume Martel, Jad Abou Khalil, Kimberly A Bertens
    Abstract:

    Prophylactic Drainage following pancreaticoduodenectomy (PD) reduces morbidity and mortality. Little evidence exists to advise on whether passive gravity (PG) or active suction (AS) Drainage systems result in superior outcomes. This study examines the relationship between Drainage system and morbidity following PD. All patients undergoing elective PD with an operatively placed drain in the 2016 ACS-NSQIP database were included. Pre- and intra-operative factors were examined. Multivariable logistic regression and coarsened exact matching (CEM) were used to assess for an association between Drainage system (PG vs. AS) and morbidity. The primary outcome was postoperative pancreatic fistula (POPF). In total, 3430 patients were included: 563 (16.4%) with PG and 2867 (83.6%) with AS Drainage system. On multivariable regression, 1787 patients were included. Drainage type was not associated with POPF, surgical site infection, delayed gastric emptying, or re-operation. AS Drainage was protective against percutaneous drain insertion (OR 0.65, 95% CI 0.44–0.96, p = 0.033). In the CEM cohort (n = 268), superficial SSI was higher in the AS group (0.8% vs. 6.0%, p = 0.036). There was a trend toward higher rates of composite total SSI (PG 15.7%, AS 23.9%, p = 0.092) and organ space SSI (PG 14.2%, AS 20.2%, p = 0.195) in the AS group; this did not demonstrate statistical significance. The findings of this study suggest that AS Drainage is protective against percutaneous drain insertion, but may be associated with increased risk of SSI. There was no relation between Drainage type and POPF. A prospective, randomized controlled trial is warranted to further explore these findings.

  • passive versus active intra Abdominal Drainage following pancreaticoduodenectomy a retrospective study using the american college of surgeons nsqip database
    World Journal of Surgery, 2021
    Co-Authors: Madeline Lemke, Lily Park, Fady Balaa, Guillaume Martel, Jad Abou Khalil, Kimberly A Bertens
    Abstract:

    BACKGROUND Prophylactic Drainage following pancreaticoduodenectomy (PD) reduces morbidity and mortality. Little evidence exists to advise on whether passive gravity (PG) or active suction (AS) Drainage systems result in superior outcomes. This study examines the relationship between Drainage system and morbidity following PD. METHODS All patients undergoing elective PD with an operatively placed drain in the 2016 ACS-NSQIP database were included. Pre- and intra-operative factors were examined. Multivariable logistic regression and coarsened exact matching (CEM) were used to assess for an association between Drainage system (PG vs. AS) and morbidity. The primary outcome was postoperative pancreatic fistula (POPF). RESULTS In total, 3430 patients were included: 563 (16.4%) with PG and 2867 (83.6%) with AS Drainage system. On multivariable regression, 1787 patients were included. Drainage type was not associated with POPF, surgical site infection, delayed gastric emptying, or re-operation. AS Drainage was protective against percutaneous drain insertion (OR 0.65, 95% CI 0.44-0.96, p = 0.033). In the CEM cohort (n = 268), superficial SSI was higher in the AS group (0.8% vs. 6.0%, p = 0.036). There was a trend toward higher rates of composite total SSI (PG 15.7%, AS 23.9%, p = 0.092) and organ space SSI (PG 14.2%, AS 20.2%, p = 0.195) in the AS group; this did not demonstrate statistical significance. CONCLUSIONS The findings of this study suggest that AS Drainage is protective against percutaneous drain insertion, but may be associated with increased risk of SSI. There was no relation between Drainage type and POPF. A prospective, randomized controlled trial is warranted to further explore these findings.

Nansheng Cheng - One of the best experts on this subject based on the ideXlab platform.

  • prophylactic Abdominal Drainage for pancreatic surgery
    Cochrane Database of Systematic Reviews, 2016
    Co-Authors: Yao Cheng, Jie Xia, Mingliang Lai, Nansheng Cheng
    Abstract:

    Background The use of surgical drains has been considered mandatory after pancreatic surgery. The role of prophylactic Abdominal Drainage to reduce postoperative complications after pancreatic surgery is controversial. Objectives To assess the benefits and harms of routine Abdominal Drainage after pancreatic surgery, compare the effects of different types of surgical drains, and evaluate the optimal time for drain removal. Search methods For the initial version of this review, we searched the Cochrane Library (2015, Issue 3), MEDLINE (1946 to 9 April 2015), Embase (1980 to 9 April 2015), Science Citation Index Expanded (1900 to 9 April 2015), and Chinese Biomedical Literature Database (CBM) (1978 to 9 April 2015). For this updated review, we searched the Cochrane Library, MEDLINE, Embase, Science Citation Index Expanded, and CBM from 2015 to 28 August 2016. Selection criteria We included all randomized controlled trials that compared Abdominal Drainage versus no Drainage in people undergoing pancreatic surgery. We also included randomized controlled trials that compared different types of drains and different schedules for drain removal in people undergoing pancreatic surgery. Data collection and analysis We identified five trials (of 985 participants) which met our inclusion criteria. Two review authors independently identified the trials for inclusion, collected the data, and assessed the risk of bias. We performed the meta-analyses using Review Manager 5. We calculated the risk ratio (RR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes with 95% confidence intervals (CI). For all analyses, we employed the random-effects model. Main results Drain use versus no drain use We included three trials involving 711 participants who were randomized to the Drainage group (N = 358) and the no Drainage group (N = 353) after pancreatic surgery. There was inadequate evidence to establish the effect of drains on mortality at 30 days (2.2% with drains versus 3.4% no drains; RR 0.78, 95% CI 0.31 to 1.99; three studies; low-quality evidence), mortality at 90 days (2.9% versus 11.6%; RR 0.24, 95% CI 0.05 to 1.10; one study; low-quality evidence), intra-Abdominal infection (7.3% versus 8.5%; RR 0.89, 95% CI 0.36 to 2.20; three studies; very low-quality evidence), wound infection (12.3% versus 13.3%; RR 0.92, 95% CI 0.63 to 1.36; three studies; low-quality evidence), morbidity (64.8% versus 62.0%; RR 1.04, 95% CI 0.93 to 1.16; three studies; moderate-quality evidence), length of hospital stay (MD -0.66 days, 95% CI -1.60 to 0.29; three studies; moderate-quality evidence), or additional open procedures for postoperative complications (11.5% versus 9.1%; RR 1.18, 95% CI 0.55 to 2.52; three studies). There was one drain-related complication in the Drainage group (0.6%). Type of drain We included one trial involving 160 participants who were randomized to the active drain group (N = 82) and the passive drain group (N = 78) after pancreatic surgery. There was no evidence of differences between the two groups in mortality at 30 days (1.2% with active drain versus 0% with passive drain), intra-Abdominal infection (0% versus 2.6%), wound infection (6.1% versus 9.0%; RR 0.68, 95% CI 0.23 to 2.05), morbidity (22.0% versus 32.1%; RR 0.68, 95% CI 0.41 to 1.15), or additional open procedures for postoperative complications (1.2% versus 7.7%; RR 0.16, 95% CI 0.02 to 1.29). The active drain group was associated with shorter length of hospital stay (MD -1.90 days, 95% CI -3.67 to -0.13; 14.1% decrease of an 'average' length of hospital stay) than in the passive drain group. The quality of evidence was low, or very low. Early versus late drain removal We included one trial involving 114 participants with a low risk of postoperative pancreatic fistula who were randomized to the early drain removal group (N = 57) and the late drain removal group (N = 57) after pancreatic surgery. There was no evidence of differences between the two groups in mortality at 30 days (0% for both groups) or additional open procedures for postoperative complications (0% with early drain removal versus 1.8% with late drain removal; RR 0.33, 95% CI 0.01 to 8.01). The early drain removal group was associated with lower rates of postoperative complications (38.5% versus 61.4%; RR 0.63, 95% CI 0.43 to 0.93), shorter length of hospital stay (MD -2.10 days, 95% CI -4.17 to -0.03; 21.5% decrease of an 'average' length of hospital stay), and hospital costs (17.0% decrease of 'average' hospital costs) than in the late drain removal group. The quality of evidence for each of the outcomes was low. Authors' conclusions It is unclear whether routine Abdominal Drainage has any effect on the reduction of mortality and postoperative complications after pancreatic surgery. In case of drain insertion, low-quality evidence suggests that active Drainage may reduce hospital stay after pancreatic surgery, and early removal may be superior to late removal for people with low risk of postoperative pancreatic fistula.

  • Abdominal Drainage to prevent intra peritoneal abscess after open appendectomy for complicated appendicitis
    Cochrane Database of Systematic Reviews, 2015
    Co-Authors: Longshuan Zhao, Nansheng Cheng, Yao Cheng, Yilei Deng
    Abstract:

    Background This is the second update of a Cochrane Review first published in 2015 and last updated in 2018. Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer postoperative complications. The routine use of Abdominal Drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial. Objectives To assess the safety and efficacy of Abdominal Drainage to prevent intraperitoneal abscess after appendectomy (irrespective of open or laparoscopic) for complicated appendicitis; to compare the effects of different types of surgical drains; and to evaluate the optimal time for drain removal. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase, Web of Science, the World Health Organization International Trials Registry Platform, ClinicalTrials.gov, Chinese Biomedical Literature Database, and three trials registers on 24 February 2020, together with reference checking, citation searching, and contact with study authors to identify additional studies. Selection criteria We included all randomised controlled trials (RCTs) that compared Abdominal Drainage versus no Drainage in people undergoing emergency open or laparoscopic appendectomy for complicated appendicitis. We also included RCTs that compared different types of drains and different schedules for drain removal in people undergoing appendectomy for complicated appendicitis. Data collection and analysis We used standard methodological procedures expected by Cochrane. Two review authors independently identified the trials for inclusion, collected the data, and assessed the risk of bias. We used the GRADE approach to assess evidence certainty. We included intraperitoneal abscess as the primary outcome. Secondary outcomes were wound infection, morbidity, mortality, hospital stay, hospital costs, pain, and quality of life. Main results Use of drain versus no drain We included six RCTs (521 participants) comparing Abdominal Drainage and no Drainage in participants undergoing emergency open appendectomy for complicated appendicitis. The studies were conducted in North America, Asia, and Africa. The majority of participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open appendectomy. None of the trials was assessed as at low risk of bias. The evidence is very uncertain regarding the effects of Abdominal Drainage versus no Drainage on intraperitoneal abscess at 30 days (risk ratio (RR) 1.23, 95% confidence interval (CI) 0.47 to 3.21; 5 RCTs; 453 participants; very low-certainty evidence) or wound infection at 30 days (RR 2.01, 95% CI 0.88 to 4.56; 5 RCTs; 478 participants; very low-certainty evidence). There were seven deaths in the Drainage group (N = 183) compared to one in the no-Drainage group (N = 180), equating to an increase in the risk of 30-day mortality from 0.6% to 2.7% (Peto odds ratio 4.88, 95% CI 1.18 to 20.09; 4 RCTs; 363 participants; low-certainty evidence). Abdominal Drainage may increase 30-day overall complication rate (morbidity; RR 6.67, 95% CI 2.13 to 20.87; 1 RCT; 90 participants; low-certainty evidence) and hospital stay by 2.17 days (95% CI 1.76 to 2.58; 3 RCTs; 298 participants; low-certainty evidence) compared to no Drainage. The outcomes hospital costs, pain, and quality of life were not reported in any of the included studies. There were no RCTs comparing the use of drain versus no drain in participants undergoing emergency laparoscopic appendectomy for complicated appendicitis. Open drain versus closed drain There were no RCTs comparing open drain versus closed drain for complicated appendicitis. Early versus late drain removal There were no RCTs comparing early versus late drain removal for complicated appendicitis. Authors' conclusions The certainty of the currently available evidence is low to very low. The effect of Abdominal Drainage on the prevention of intraperitoneal abscess or wound infection after open appendectomy is uncertain for patients with complicated appendicitis. The increased rates for overall complication rate and hospital stay for the Drainage group compared to the no-Drainage group are based on low-certainty evidence. Consequently, there is no evidence for any clinical improvement with the use of Abdominal Drainage in patients undergoing open appendectomy for complicated appendicitis. The increased risk of mortality with Drainage comes from eight deaths observed in just under 400 recruited participants. Larger studies are needed to more reliably determine the effects of Drainage on morbidity and mortality outcomes.

  • Abdominal Drainage to prevent intra peritoneal abscess after open appendectomy for complicated appendicitis
    Cochrane Database of Systematic Reviews, 2015
    Co-Authors: Yao Cheng, Shiyi Zhou, Rongxing Zhou, Jiong Lu, Sijia Wu, Xianze Xiong, Hui Ye, Taixiang Wu, Nansheng Cheng
    Abstract:

    BACKGROUND: Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer from postoperative complications. The routine use of Abdominal Drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial.This is an update of the review first published in 2015. OBJECTIVES: To assess the safety and efficacy of Abdominal Drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 6), Ovid MEDLINE (1946 to 30 June 2017), Ovid Embase (1974 to 30 June 2017), Science Citation Index Expanded (1900 to 30 June 2017), World Health Organization International Clinical Trials Registry Platform (30 June 2017), ClinicalTrials.gov (30 June 2017) and Chinese Biomedical Literature Database (CBM) (1978 to 30 June 2017). SELECTION CRITERIA: We included all randomised controlled trials (RCTs) that compared Abdominal Drainage and no Drainage in people undergoing emergency open appendectomy for complicated appendicitis. DATA COLLECTION AND ANALYSIS: Two review authors identified the trials for inclusion, collected the data, and assessed the risk of bias independently. We performed the meta-analyses using Review Manager 5. We calculated the risk ratio (RR) for dichotomous outcomes (or a Peto odds ratio for very rare outcomes), and the mean difference (MD) for continuous outcomes with 95% confidence intervals (CI). We used GRADE to rate the quality of evidence. MAIN RESULTS: We included six RCTs (521 participants), comparing Abdominal Drainage and no Drainage in patients undergoing emergency open appendectomy for complicated appendicitis. The studies were conducted in North America, Asia and Africa. The majority of the participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open appendectomy. None of the trials was at low risk of bias.There was insufficient evidence to determine the effects of Abdominal Drainage and no Drainage on intra-peritoneal abscess at 14 days (RR 1.23, 95% CI 0.47 to 3.21; 5 RCTs; 453 participants; very low-quality evidence) or for wound infection at 14 days (RR 2.01, 95% CI 0.88 to 4.56; 5 RCTs; 478 participants; very low-quality evidence). The increased risk of 30-day overall complication rate (morbidity) in the Drainage group was rated as very low-quality evidence (RR 6.67, 95% CI 2.13 to 20.87; 1 RCT; 90 participants). There were seven deaths in the Drainage group (N = 183) compared to one in the no Drainage group (N = 180), equating to an increase in the risk of 30-day mortality from 0.6% to 2.7% (Peto odds ratio (OR) 4.88, 95% CI 1.18 to 20.09; 4 RCTs; 363 participants; moderate-quality evidence). There is 'very low-quality' evidence that Drainage increases hospital stay compared to the no Drainage group by 2.17 days (95% CI 1.76 to 2.58; 3 RCTs; 298 participants).Other outlined outcomes, hospital costs, pain, and quality of life, were not reported in any of the included studies. AUTHORS' CONCLUSIONS: The quality of the current evidence is very low. The effect of Abdominal Drainage on the prevention of intra-peritoneal abscess or wound infection after open appendectomy is uncertain for patients with complicated appendicitis. The increased rates for overall complication rate and hospital stay for the Drainage group compared to no Drainage group is also subject to great uncertainty. Thus, there is no evidence for any clinical improvement by using Abdominal Drainage in patients undergoing open appendectomy for complicated appendicitis. The increased risk of mortality with Drainage comes from eight deaths observed in just under 400 people recruited to the studies. Larger studies are needed to determine the effects of Drainage on morbidity and mortality outcomes more reliably.

Guillaume Martel - One of the best experts on this subject based on the ideXlab platform.

  • passive versus active intra Abdominal Drainage following pancreaticoduodenectomy a retrospective study using the american college of surgeons nsqip database
    World Journal of Surgery, 2021
    Co-Authors: Madeline Lemke, Lily Park, Fady Balaa, Guillaume Martel, Jad Abou Khalil, Kimberly A Bertens
    Abstract:

    Prophylactic Drainage following pancreaticoduodenectomy (PD) reduces morbidity and mortality. Little evidence exists to advise on whether passive gravity (PG) or active suction (AS) Drainage systems result in superior outcomes. This study examines the relationship between Drainage system and morbidity following PD. All patients undergoing elective PD with an operatively placed drain in the 2016 ACS-NSQIP database were included. Pre- and intra-operative factors were examined. Multivariable logistic regression and coarsened exact matching (CEM) were used to assess for an association between Drainage system (PG vs. AS) and morbidity. The primary outcome was postoperative pancreatic fistula (POPF). In total, 3430 patients were included: 563 (16.4%) with PG and 2867 (83.6%) with AS Drainage system. On multivariable regression, 1787 patients were included. Drainage type was not associated with POPF, surgical site infection, delayed gastric emptying, or re-operation. AS Drainage was protective against percutaneous drain insertion (OR 0.65, 95% CI 0.44–0.96, p = 0.033). In the CEM cohort (n = 268), superficial SSI was higher in the AS group (0.8% vs. 6.0%, p = 0.036). There was a trend toward higher rates of composite total SSI (PG 15.7%, AS 23.9%, p = 0.092) and organ space SSI (PG 14.2%, AS 20.2%, p = 0.195) in the AS group; this did not demonstrate statistical significance. The findings of this study suggest that AS Drainage is protective against percutaneous drain insertion, but may be associated with increased risk of SSI. There was no relation between Drainage type and POPF. A prospective, randomized controlled trial is warranted to further explore these findings.

  • passive versus active intra Abdominal Drainage following pancreaticoduodenectomy a retrospective study using the american college of surgeons nsqip database
    World Journal of Surgery, 2021
    Co-Authors: Madeline Lemke, Lily Park, Fady Balaa, Guillaume Martel, Jad Abou Khalil, Kimberly A Bertens
    Abstract:

    BACKGROUND Prophylactic Drainage following pancreaticoduodenectomy (PD) reduces morbidity and mortality. Little evidence exists to advise on whether passive gravity (PG) or active suction (AS) Drainage systems result in superior outcomes. This study examines the relationship between Drainage system and morbidity following PD. METHODS All patients undergoing elective PD with an operatively placed drain in the 2016 ACS-NSQIP database were included. Pre- and intra-operative factors were examined. Multivariable logistic regression and coarsened exact matching (CEM) were used to assess for an association between Drainage system (PG vs. AS) and morbidity. The primary outcome was postoperative pancreatic fistula (POPF). RESULTS In total, 3430 patients were included: 563 (16.4%) with PG and 2867 (83.6%) with AS Drainage system. On multivariable regression, 1787 patients were included. Drainage type was not associated with POPF, surgical site infection, delayed gastric emptying, or re-operation. AS Drainage was protective against percutaneous drain insertion (OR 0.65, 95% CI 0.44-0.96, p = 0.033). In the CEM cohort (n = 268), superficial SSI was higher in the AS group (0.8% vs. 6.0%, p = 0.036). There was a trend toward higher rates of composite total SSI (PG 15.7%, AS 23.9%, p = 0.092) and organ space SSI (PG 14.2%, AS 20.2%, p = 0.195) in the AS group; this did not demonstrate statistical significance. CONCLUSIONS The findings of this study suggest that AS Drainage is protective against percutaneous drain insertion, but may be associated with increased risk of SSI. There was no relation between Drainage type and POPF. A prospective, randomized controlled trial is warranted to further explore these findings.

Fady Balaa - One of the best experts on this subject based on the ideXlab platform.

  • passive versus active intra Abdominal Drainage following pancreaticoduodenectomy a retrospective study using the american college of surgeons nsqip database
    World Journal of Surgery, 2021
    Co-Authors: Madeline Lemke, Lily Park, Fady Balaa, Guillaume Martel, Jad Abou Khalil, Kimberly A Bertens
    Abstract:

    Prophylactic Drainage following pancreaticoduodenectomy (PD) reduces morbidity and mortality. Little evidence exists to advise on whether passive gravity (PG) or active suction (AS) Drainage systems result in superior outcomes. This study examines the relationship between Drainage system and morbidity following PD. All patients undergoing elective PD with an operatively placed drain in the 2016 ACS-NSQIP database were included. Pre- and intra-operative factors were examined. Multivariable logistic regression and coarsened exact matching (CEM) were used to assess for an association between Drainage system (PG vs. AS) and morbidity. The primary outcome was postoperative pancreatic fistula (POPF). In total, 3430 patients were included: 563 (16.4%) with PG and 2867 (83.6%) with AS Drainage system. On multivariable regression, 1787 patients were included. Drainage type was not associated with POPF, surgical site infection, delayed gastric emptying, or re-operation. AS Drainage was protective against percutaneous drain insertion (OR 0.65, 95% CI 0.44–0.96, p = 0.033). In the CEM cohort (n = 268), superficial SSI was higher in the AS group (0.8% vs. 6.0%, p = 0.036). There was a trend toward higher rates of composite total SSI (PG 15.7%, AS 23.9%, p = 0.092) and organ space SSI (PG 14.2%, AS 20.2%, p = 0.195) in the AS group; this did not demonstrate statistical significance. The findings of this study suggest that AS Drainage is protective against percutaneous drain insertion, but may be associated with increased risk of SSI. There was no relation between Drainage type and POPF. A prospective, randomized controlled trial is warranted to further explore these findings.

  • passive versus active intra Abdominal Drainage following pancreaticoduodenectomy a retrospective study using the american college of surgeons nsqip database
    World Journal of Surgery, 2021
    Co-Authors: Madeline Lemke, Lily Park, Fady Balaa, Guillaume Martel, Jad Abou Khalil, Kimberly A Bertens
    Abstract:

    BACKGROUND Prophylactic Drainage following pancreaticoduodenectomy (PD) reduces morbidity and mortality. Little evidence exists to advise on whether passive gravity (PG) or active suction (AS) Drainage systems result in superior outcomes. This study examines the relationship between Drainage system and morbidity following PD. METHODS All patients undergoing elective PD with an operatively placed drain in the 2016 ACS-NSQIP database were included. Pre- and intra-operative factors were examined. Multivariable logistic regression and coarsened exact matching (CEM) were used to assess for an association between Drainage system (PG vs. AS) and morbidity. The primary outcome was postoperative pancreatic fistula (POPF). RESULTS In total, 3430 patients were included: 563 (16.4%) with PG and 2867 (83.6%) with AS Drainage system. On multivariable regression, 1787 patients were included. Drainage type was not associated with POPF, surgical site infection, delayed gastric emptying, or re-operation. AS Drainage was protective against percutaneous drain insertion (OR 0.65, 95% CI 0.44-0.96, p = 0.033). In the CEM cohort (n = 268), superficial SSI was higher in the AS group (0.8% vs. 6.0%, p = 0.036). There was a trend toward higher rates of composite total SSI (PG 15.7%, AS 23.9%, p = 0.092) and organ space SSI (PG 14.2%, AS 20.2%, p = 0.195) in the AS group; this did not demonstrate statistical significance. CONCLUSIONS The findings of this study suggest that AS Drainage is protective against percutaneous drain insertion, but may be associated with increased risk of SSI. There was no relation between Drainage type and POPF. A prospective, randomized controlled trial is warranted to further explore these findings.

Jad Abou Khalil - One of the best experts on this subject based on the ideXlab platform.

  • passive versus active intra Abdominal Drainage following pancreaticoduodenectomy a retrospective study using the american college of surgeons nsqip database
    World Journal of Surgery, 2021
    Co-Authors: Madeline Lemke, Lily Park, Fady Balaa, Guillaume Martel, Jad Abou Khalil, Kimberly A Bertens
    Abstract:

    Prophylactic Drainage following pancreaticoduodenectomy (PD) reduces morbidity and mortality. Little evidence exists to advise on whether passive gravity (PG) or active suction (AS) Drainage systems result in superior outcomes. This study examines the relationship between Drainage system and morbidity following PD. All patients undergoing elective PD with an operatively placed drain in the 2016 ACS-NSQIP database were included. Pre- and intra-operative factors were examined. Multivariable logistic regression and coarsened exact matching (CEM) were used to assess for an association between Drainage system (PG vs. AS) and morbidity. The primary outcome was postoperative pancreatic fistula (POPF). In total, 3430 patients were included: 563 (16.4%) with PG and 2867 (83.6%) with AS Drainage system. On multivariable regression, 1787 patients were included. Drainage type was not associated with POPF, surgical site infection, delayed gastric emptying, or re-operation. AS Drainage was protective against percutaneous drain insertion (OR 0.65, 95% CI 0.44–0.96, p = 0.033). In the CEM cohort (n = 268), superficial SSI was higher in the AS group (0.8% vs. 6.0%, p = 0.036). There was a trend toward higher rates of composite total SSI (PG 15.7%, AS 23.9%, p = 0.092) and organ space SSI (PG 14.2%, AS 20.2%, p = 0.195) in the AS group; this did not demonstrate statistical significance. The findings of this study suggest that AS Drainage is protective against percutaneous drain insertion, but may be associated with increased risk of SSI. There was no relation between Drainage type and POPF. A prospective, randomized controlled trial is warranted to further explore these findings.

  • passive versus active intra Abdominal Drainage following pancreaticoduodenectomy a retrospective study using the american college of surgeons nsqip database
    World Journal of Surgery, 2021
    Co-Authors: Madeline Lemke, Lily Park, Fady Balaa, Guillaume Martel, Jad Abou Khalil, Kimberly A Bertens
    Abstract:

    BACKGROUND Prophylactic Drainage following pancreaticoduodenectomy (PD) reduces morbidity and mortality. Little evidence exists to advise on whether passive gravity (PG) or active suction (AS) Drainage systems result in superior outcomes. This study examines the relationship between Drainage system and morbidity following PD. METHODS All patients undergoing elective PD with an operatively placed drain in the 2016 ACS-NSQIP database were included. Pre- and intra-operative factors were examined. Multivariable logistic regression and coarsened exact matching (CEM) were used to assess for an association between Drainage system (PG vs. AS) and morbidity. The primary outcome was postoperative pancreatic fistula (POPF). RESULTS In total, 3430 patients were included: 563 (16.4%) with PG and 2867 (83.6%) with AS Drainage system. On multivariable regression, 1787 patients were included. Drainage type was not associated with POPF, surgical site infection, delayed gastric emptying, or re-operation. AS Drainage was protective against percutaneous drain insertion (OR 0.65, 95% CI 0.44-0.96, p = 0.033). In the CEM cohort (n = 268), superficial SSI was higher in the AS group (0.8% vs. 6.0%, p = 0.036). There was a trend toward higher rates of composite total SSI (PG 15.7%, AS 23.9%, p = 0.092) and organ space SSI (PG 14.2%, AS 20.2%, p = 0.195) in the AS group; this did not demonstrate statistical significance. CONCLUSIONS The findings of this study suggest that AS Drainage is protective against percutaneous drain insertion, but may be associated with increased risk of SSI. There was no relation between Drainage type and POPF. A prospective, randomized controlled trial is warranted to further explore these findings.