Validation of the triple-checked criteria for drain management after pancreatectomy.

Abstract

Drain management is important for the detection and treatment of clinically relevant postoperative pancreatic fistula (CR-POPF). We previously established the triple-checked criteria for drain removal: drain fluid amylase (DFA) <5000U/L on postoperative day (POD) 1 and DFA <3000U/L on POD 3, or C-reactive protein <15mg/dL on POD 3. This study aimed to validate the efficacy of the triple-checked criteria. In this study, 681 patients who underwent pancreatectomy were included. Drains were removed according to our previous criteria (sequentially checked criteria: DFA <5000U/L on POD 1 and DFA <3000U/L on POD 3) from 2012 to 2016 (control group) and the triple-checked criteria from 2017 to 2019 (intervention group). The control group included 406 patients, and the intervention group included 275 patients. Significantly more patients (n=237, 86.2%) met the triple-checked criteria in the intervention group, relative to the sequentially checked criteria for early drain removal policy (n=309, 76.1%; P=.001). Sensitivity, accuracy, and negative predictive value were significantly higher in the intervention group than in the control group (P<.001). The incidence of CR-POPF was not significantly different (11.1% vs 13.8%, P=.285). The triple-checked criteria contributed to effective drain removal after pancreatectomy without increasing CR-POPF.