Abstract
IntroductionThe drain output volume (DOV) after pancreaticoduodenectomy (PD) is an easily assessable indicator in clinical settings. We explored the utility of the DOV as a possible warning sign of complications after PD.MethodsA total of 404 patients undergoing PD were considered for inclusion. The predictability of the DOV for overall morbidity, major complications, intraabdominal infection (IAI), clinically relevant (CR) postoperative pancreatic fistula (POPF), CR delayed gastric emptying (DGE), CR chyle leak (CL), and CR post-pancreatectomy hemorrhaging (PPH) was evaluated.ResultsOne hundred (24.8%) patients developed major complications, and 131 (32.4%) developed IAI. Regarding CR post-pancreatectomy complications, 75 (18.6%) patients developed CR-POPF, 23 (5.7%) developed CR-DGE, 20 (5.0%) developed CR-CL, and 28 (6.9%) developed CR-PPH. The median DOV on postoperative day (POD) 1 and POD 3 was 266 and 234.5 ml, respectively. A low DOV on POD 1 was an independent predictor of CR-POPF, and a high DOV on POD 3 was an independent predictor of CR-CL. A receiver operating characteristics (ROC) analysis revealed that the DOV on POD 1 had a negative predictive value (area under the curve [AUC] 0.655, sensitivity 65.0%, specificity 65.3%, 95% confidence interval [CI]: 0.587–0.724), with a calculated optimal cut-off value of 227 ml. An ROC analysis also revealed that the DOV on POD 3 had a positive predictive value (AUC 0.753, sensitivity 70.1%, specificity 75.0%, 95% CI: 0.651–0.856), with a calculated optimal cut-off value of 332 ml.ConclusionA low DOV on POD 1 might be a postoperative warning sign for CR-POPF, similar to high drain amylase (DA) on POD 1, high DA on POD 3, and high CRP on POD 3. When the DOV on POD 1 after PD was low, surgeons should evaluate the reasons of a low DOV. A high DOV on POD 3 was a postoperative warning sign CR-CL, and might require an appropriate management of protein loss.
Highlights
The drain output volume (DOV) after pancreaticoduodenectomy (PD) is an assessable indicator in clinical settings
Recent studies have shown that a positive bacterial culture in drain output after PD is associated with increased incidences of complications, including clinically relevant (CR)-postoperative pancreatic fistula (POPF), major complications and reoperation [8, 9]
Predictability of the DOV for postoperative complications The development of major complications, intraabdominal infection (IAI), CR-POPF, CR-chyle leak (CL) and CR-post-pancreatectomy hemorrhage (PPH) was shown to be correlated with the DOV on postoperative day (POD) 1 and/or POD 3, so we further evaluated the independent postoperative warning sign for these complications by multivariate analyses
Summary
The drain output volume (DOV) after pancreaticoduodenectomy (PD) is an assessable indicator in clinical settings. DA has been used in clinical settings to predict POPF, and a high DA on POD 1 and POD 3 has been repeatedly reported to be a strong postoperative warning sign of clinically. Recent studies have shown that a positive bacterial culture in drain output after PD is associated with increased incidences of complications, including CR-POPF, major complications and reoperation [8, 9]. The drain output after PD has been studied for its predictability for postoperative complications. The drain output volume (DOV) after PD is an assessable indicator in the clinical setting. A few studies have reported that a high DOV is associated with severe dehydration and protein loss, and patients with a high DOV may require a longer hospital stay to manage their massive fluid loss [13, 14]
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