256 The Effect of Intraperitoneal Drain Placement on Postoperative Outcomes After Emergency Colorectal Surgery: A Propensity-Score Matched Analysis

Abstract

Abstract Introduction The use of intraperitoneal drain placement after emergency colorectal surgery is controversial. While the general consensus recommends against their routine use, there remains a paucity of evidence supporting this in the setting of emergency colorectal surgery. This study aimed to describe the efficacy and safety of intraperitoneal drain placement. Method This was a prospective, international, cohort study including consecutive adult patients undergoing emergency colorectal surgery (February-March 2020). Outcomes included: rate and time to diagnosis of intraperitoneal postoperative collections; rate of drain-related complications; and 30-day major postoperative complications (Clavien–Dindo grade ≥3). After propensity-score matching, multivariable logistic and Cox proportional hazards regressions were used to estimate the independent association of the outcomes with drain placement. Results Some 730 patients were included (353 females; median age 68.5 years, IQR 20) and the drain-placement rate was 53.6% (391/730). After matching, drains were not associated with lower rates of intraperitoneal postoperative collections (OR 1.30, 95% CI: 0.62–2.75, p=0.486) nor did they allow for earlier detection of such collections (HR 0.76, 95% CI: 0.19–3.05, p=0.698). Although not associated with worse major postoperative complications (OR 1.10, 95% CI: 0.63–1.90, p=0.740), drains carried an increased surgical site infection (SSI) risk (OR 3.41, 95% CI: 1.78–6.52, p<0.001). Conclusions This is the first study on the role of intraperitoneal drains in emergency colorectal surgery. Drains did not confer any clear clinical benefits after emergency colorectal surgery, but they were associated with increased SSI risk. Further trial evidence is needed to establish their net overall benefit or harm.