255 International Variation in Intraperitoneal Drain Placement and Outcomes After Elective Colorectal Surgery: A Matched, Prospective, Cohort Study

Abstract

Abstract Background Currently, many surgeons place intraperitoneal drains after elective colorectal surgery. However, Enhanced Recovery After Surgery (ERAS) guidelines recommend against their routine use due to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Method COMPlicAted intra-abdominal collectionS after colorectal Surgery (COMPASS) was a prospective, international, cohort study which enrolled consecutive adult patients undergoing elective colorectal surgery (February-March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time-to-diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time-to-discharge; 30-day major postoperative complications (Clavien–Dindo grade ≥3). After propensity-score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 [44.2%] female; median age 67.0 years). The drain insertion rate was 51.9% (n=937). After matching, drains were not associated with reduced rates (OR 1.33, 95% CI: 0.79–2.23, p=0.287) or earlier detection of collections (HR 0.87, 95% CI: 0.33–2.31, p=0.780). Although not associated with worse major postoperative complications (OR 1.09, 95% CI: 0.68–1.75, p=0.709), drains were associated with delayed hospital discharge (HR 0.58, 95% CI: 0.52–0.66, p<0.001) and increased risk of SSIs (OR 2.47, 95% CI: 1.50–4.05, p<0.001). Conclusions Intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of collections but were associated with prolonged length of stay and increased SSI risk.