Abstract
Objective: We analyzed the outcomes of patients who had preoperative biliary drainage and/or intraoperative drains placed during pancreaticoduodenectomy compared to their non-intervention controls using ACS-NSQIP data. Methods: Retrospective review of 2014 NSQIP data was performed on patients undergoing pancreaticoduodenectomy. Demographic characteristics, length of stay, operative time, and 30-day postoperative complications were compared between study groups. Results: Patients without preoperative biliary drainage [1406/2968 (47%)] had more pancreatic fistulas (20.6% vs 15.9%, p=0.001), less SSI (6.5% vs 12.5%, p<0.001), less wound disruption (1.2% vs 2.2%, p=0.043), more pulmonary embolus (1.7% vs 0.6%, p=0.006), less transfusion requirement (18.1% vs 24.6%, p<0.001), less postoperative sepsis (7.5% vs 11.5%, p<0.001), shorter operative time (370 min vs 380 min, p=0.029) and decreased overall morbidity (53.6% vs 59.9%, p=0.001) compared to controls. Patients who did not have a drain placed at surgery (ND) [393/3108 (13%)] had less pancreatic fistulas (9.2% vs 19.5%, p<0.001), less transfusion requirements (15.4% vs 22.2%, p<0.001), more pneumonia (8.7% vs 4.1%, p<0.001), more post-operative shock (5.6% vs 3.5%, p=0.037), shorter LOS (9.7 d vs 11.3 d, p=0.003), shorter operative time (361 min vs 377 min, p=0.024) and decreased overall morbidity (47.6% vs 58.2%, p<0.001) compared to controls. Multivariate analysis revealed intraoperative drain placement (OR 2.03, p<0.001) and preoperative biliary drainage (OR 1.35, p=0.002) as independent predictors of overall morbidity. Conclusion: In this retrospective review of ACS-NSQIP data, both preoperative biliary drainage and intraoperative drainage of anastomoses in pancreaticoduodenectomies were independent predictors of overall morbidity.
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