Abstract
Objective: Many liver surgeons continue to routinely insert drains after uncomplicated hepatic resections. However, small randomized trials and a Cochran Systematic Review do not support this practice. The aim of this analysis was to use a multi-institution database to compare matched patients undergoing a major hepatic resection who did and did not have drains placed at surgery. Methods: The 2014 Procedure Targeted Hepatectomy National Surgical Quality Improvement Program (NSQIP) Participant Use File was queried for right, left or extended hepatectomies. Liver resections with a concomitant colectomy or hepaticojejunostomy were excluded. Patients with and without drains were matched for age, gender, ASA class, BMI, multiple comorbidities, liver function, wound class, operative approach, resection type and pathology. Both univariate comparisons and multivariable logistic regression models were performed to access outcomes. Results: Of 3084 hepatectomies, 787 (26%) were major resections. Propensity score matching resulted in 544 patients with (n=272) or without (n=272) drains. Drain and No Drain patients did not differ with respect to overall morbidity, mortality, reoperations or length of stay. Outcomes which were better in the No Drain patients are presented in the Table. Conclusion: Drain placement after major hepatectomy results in more surgical site infections, bile leaks, interventions for leaks and readmissions. Bile leaks are associated with multiple post hepatectomy adverse outcomes. Routine drain placement is not warranted after major hepatectomy.Tabled 1DrainAny SSI (%)Bile leak (%)Leak intervention (%)Re-admission (%)No7.75.22.34.8Yes15.4*16.2*6.4†16.2**p<0.001, †p<0.001 vs No Drain Open table in a new tab *p<0.001, †p<0.001 vs No Drain
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