Drain Size Research Articles

3:45 PM Abstract No. 104 Percutaneous management of biliary strictures following orthotopic liver transplantation: long-term outcomes analysis

To retrospectively evaluate long-term outcomes following percutaneous biliary drainage (PBD) for treatment of posttransplant biliary stricture. Patients with posttransplant biliary stricture managed with an institutional protocol of PBD placement, serial drain upsize and cholangioplasty were reviewed. Biliary drains were removed if cholangiogram demonstrated unobstructed biliary flow, and liver function tests remained stable after placement of an end-hole 5Fr catheter. Stricture patency rates following drain removal were estimated using the Kaplan-Meier method and compared between groups using the Log-rank test. Cox regression analysis was performed to identify predictors of recurrent biliary stricture. 25 patients (15 males, 10 females) were identified for analysis. Patients with primary sclerosing cholangitis comprised the largest subgroup (n = 13, 52%). 40% (n = 10) had anastomotic strictures, 44% (n = 11) had non-anastomotic strictures, and 16% (n = 4) had multifocal strictures. 68% (n = 17) had a single drain, 28% (n = 7) had two drains, and 4% (n = 1) had three or more drains. 44% (n = 11) underwent failed endoscopic treatment prior to PBD. The median duration of biliary drainage was 302 days. 72% patency rate was observed following drain removal at up to 148 months. 8% of patients (n = 2) failed PBD and underwent surgical revision (n = 1) or re-transplant (n = 1). Following drain removal, 20% (n = 5) developed repeat biliary stricture necessitating re-intervention (repeat PBD, n = 4 and repeat transplant, n = 1). Significantly decreased stricture patency was observed for patients requiring multiple vs. single drain (P = 0.034). In univariate analysis, larger final drain size (HR: 0.21, P = 0.027) was associated with lower hazards of drain failure while increased drain dwell time was associated with a higher hazard of drain failure (HR: 1.09, P = 0.020). Percutaneous management of posttransplant biliary stricture provided long-term stricture patency in 72% of patients. Repeat transplant or surgery was needed in 12%. Larger final drain size and increased drain dwell time are associated with higher and lower patency rates, respectively.

Optimization of horizontal drain dimensions in heterogeneous earth dams using Artificial Neural Network (ANN): A case study on Marvak dam

Designing and optimizing the dimensions of the drainage system in order to keep the crust dry and prevent the increase in pore water pressure in the body of the earth dams is very important. On the other hand, finding the minimum factor of safety (FoS) and, consequently, reducing the cost of construction, will be possible by optimizing the dimensions of the drain. In this paper, Geostudio software is used to simulate Marvak dam with real dimensions and parameters to calculate its factor of safety. For different values, the parameters affecting the dam factor of safety are calculated, and then the maximum effect of each of them on the dam factor of safety is determined in the case of an equal condition. Then, these factors are classified in terms of costs and impact on the dam factor of safety and each of them is used to optimize dam construction costs or to provide the required factor of safety of the dam. In the following, a two-layer neural network will be considered in the Matlab software. The neural network is then trained on the basis of the data obtained for the dam barrier to predict the dam factor of safety. Then the trained neural network function is extracted and for producing dam factor of safety in the optimization problem. The objective of the optimization is to minimize the size of the dam drain so that the dam construction cost is optimized and a minimum factor of safety of the dam is provided. To solve this problem, an optimization of Mfile is tailored to the neural network function, which is calculated by executing the optimal values of the dam parameters.

Factors Affecting Outcome Following Video-Assisted Thoracoscopic Surgery for Empyema in Children: Experience from a Large Tertiary Referring Centre.

Introduction: We report the results of video-assisted thoracoscopic surgery (VATS) in a large population of children with empyema, focusing on the factors affecting the postoperative length of stay (LOS). Materials and Methods: After ethical approval (RES-18-0000-071Q), a retrospective review was performed (2013-2018). Results are reported as number of cases (%) and median (range) and analyzed by Mann-Whitney U and Kruskal-Wallis tests. Correlation analysis was conducted. Results: We identified 159 children with empyema; 75 [42 (56%) males] underwent VATS. Median age was 3.6 (0.4-14.5) years. Presentation was: autumn 15 (20%), winter 26 (35%), spring 18 (24%), summer 16 (21%) with no difference in LOS (P = .6). Preoperative symptoms duration was 7 (2-28) days. Postoperatively, chest drain was on suction in 30 (40%) patients, in situ for 3 (2-13) days. Six (8%) children required further procedures. LOS was 8 (3-47) days. Pleural fluid revealed: Streptococcus species. 41 (55%), other species 8 (11%), no bacteria 26 (34%); LOS was longer with positive pleural fluid: 9 (4-47) versus 6.5 (3-16) days (P = .02). There was no correlation between the LOS and preoperative symptoms duration (r = -0.03 [95% CI -0.3 to 0.2]; P = .7), empyema size (r = 0.2 [95% CI -0.07 to 0.5]; P = .1) and chest drain size (r = 0.09 [95% CI -0.14 to 0.3]; P = .4). Discussion: In our experience, >90% of children with empyema will be treated with a single VATS with an average LOS of 8 days. Positive microbiology culture significantly affects the LOS.

Design approach for interceptor tile drains using hydrus

Abstract Seepage from irrigation canals can be controlled by interceptor pipe drains located down slope of the canal embankment and parallel to the canal. HYDRUS (2D/3D) is a software that simulates water flow in two-dimensional variably-saturated porous media. This software is used to determine the average water contents of the upper layers, direction of flow and the seepage rate to the pipe drain for different values of evaporation rates, pipe diameters, and horizontal and vertical pipe offsets from the conveyance canal. The results showed that increasing the vertical offset (drain depth) increases the drain discharge. Moreover, increasing the horizontal offset reduces the canal seepage and lower the phreatic surface. The proposed approach can determine drain size and location to cut off canal seepage, ensuring no contribution to the water body under the irrigated lands beyond the drain. The approach accounts for realistic soil formations and considers both saturated and capillary flows.

Computational fluid dynamics characterization of a novel mixed cell raceway design

Computational fluid dynamics (CFD) analysis was performed on a new type of mixed cell raceway (MCR) that incorporates longitudinal plug flow using inlet and outlet weirs for the primary fraction of the total flow. As opposed to conventional MCR’s wherein vortices are entirely characterized by the boundary conditions at inlet nozzles and outlet center drains in the center of each cell, the new MCR design can develop a wider variety of fluid behaviors due to the additional boundary conditions at the inlet and outlet walls where the weirs are placed. In this study, we investigated how the primary longitudinal flow would affect vortex formations in the cells by designing three different MCR models and simulating three major cases for each model. Through this process, performances of two numerical CFD models (transition k-kl-ω vs. k-ε) were compared, along with two vortex quantification methods (Q-criterion vs. a proposed method). We found that the k-kl-ω CFD model more accurately predicted vortex formation than the k-ε model. The three MCR models differed only by weir geometry or drain size, in order to see their individual influence on cell vortex formation. Each case had its own unique weir flow rate and center drain loading rate values that combined to a total flow rate resulting in 15-min hydraulic retention time (HRT) for the MCR. The ratio of (expressed as percentage) of center drain loading rate to total flow rate (R = 7.5%, 12.5%, and 20.1%.) was defined to establish a relationship between R and vortex strength or size. Simulations demonstrated that inlet weir aspect ratio impacted cell vortex formation and strength. Unlike weir geometry effects, the drain size had non-significant impacts on fluid behavior other than the velocity very near the drains. While R did have positive correlations with vortex strength, vortex size, and self-cleaning performance, an R of 20.1% was sufficient to create uninterrupted vortex formations. Too low of a center drain rate or R value can result in lack of any meaningful cell vortex formation which then obviates any self-cleaning action in an MCR. Our key finding through extensive computational analysis was that an R value of 20% was required in order to maintain effective vortex formation. Expressed more explicitly, this can be described as maintaining a center drain loading rate of 0.010094 m3/s per cell (160 gpm), which correspond to unit loading rates of 16.3 lpm/m2 per cell (0.40 gpm/ft2 per cell).

Structured Protocol for Benign Biliary Anastomotic Strictures: Impact on Long-Term Clinical Effectiveness

The purpose of this study is to compare long-term clinical effectiveness before and after implementation of a structured protocol for percutaneous drainage of benign anastomotic biliary strictures. Three hundred five adult patients undergoing percutaneous biliary drainage for biliary anastomotic strictures between 1994 and 2015 were identified using Current Procedural Terminology billing codes, with 234 undergoing intervention before implementation of a structured protocol and 71 undergoing intervention after implementation of the protocol. The frequency of surgical anastomotic revision was compared between patients treated before and after the implementation of the structured protocol. Patient characteristics and treatment variables were also analyzed with respect to the frequency of surgical revision. A Kaplan-Meier analysis was performed to determine the long-term probabilities of avoiding surgical revision and patency rates. Overall, 72.8% of patients avoided surgical revision, with 71.1% before and 81.7% after the protocol was implemented (p = 0.1052). A larger maximum drain size was significantly associated with a lower frequency of surgical revision (p = 0.0006). The rates of surgical avoidance 5 years after treatment before and after protocol implementation were 69.1% and 80.8%, respectively. Patency rates 5 years after treatment before and after protocol implementation were 73.8% and 76.8%, respectively. Percutaneous drainage and management of benign biliary anastomotic strictures is an effective treatment regardless of the presence of a structured protocol. Although there was no significant benefit in terms of avoidance of surgical revision, the time until surgical revision and patency rates were increased with the protocol. In addition, a larger maximum drain size was associated with a better outcome.

Chest drain size: Does it matter?

Pleural disease is common with an increasing incidence and so represents a significant proportion of the workload for respiratory physicians. Chest drain insertion continues to be considered a mainstay of pleural disease management however the optimum drain size required for various pleural conditions remains unclear. Traditionally large-bore chest drains were inserted through a surgical technique of blunt dissection however smaller bore Seldinger (guidewire) drains have dramatically increased in popularity in recent times most likely due to ease of insertion and perceived increased patient tolerability. Despite British Thoracic Society Guidelines advocating a preference for small-bore chest drains, their use remains controversial. We aim to review the literature in each category of pleural disease including pneumothorax, malignant pleural effusion and pleural infection, regarding chest drain size, comparing the role, effectiveness and complications of each.

Chest drain size: does it matter?

Chest drain size: does it matter?

Proactive Versus Standard Percutaneous Catheter Drainage for Infected Necrotizing Pancreatitis.

Percutaneous catheter drainage (PCD) is often the first invasive treatment step for infected necrotizing pancreatitis. A proactive PCD strategy, including frequent and early drain revising and upsizing, may reduce the need for surgical necrosectomy and could improve outcomes, but data are lacking. Necrotizing pancreatitis patients were identified from in-hospital databases (2004-2014). Patients with primary PCD for infected necrotizing pancreatitis were included. Outcomes of patients from 1 center using a proactive PCD strategy were compared with 3 standard strategy centers. In total, 369 (25.9%) of 1427 patients received a diagnosis of necrotizing pancreatitis, and 117 (31.7%) of 369 patients underwent primary PCD for infected necrosis: 42 in the proactive group versus 75 in the standard group. Patients in the proactive group had more drain-related procedures (median, 3; interquartile range [IQR], 2-4; versus 2; IQR, 1-2; P < 0.001) and larger final drain sizes (median, 16F; IQR, 14F-20F; versus 14F; IQR, 12F-14F; P < 0.001). Fewer patients underwent additional necrosectomy in the proactive group, 12 (28.6%) versus 39 (52.0%) (adjusted odds ratio, 0.349; 95% confidence interval, 0.137-0.889; P = 0.027), with similar hospital stay and mortality. A proactive PCD strategy is associated with reduced need for necrosectomy in infected necrotizing pancreatitis, compared with standard PCD, with similar clinical outcomes.

Modelling Scenarios to Estimate the Potential Impact of Hydrological Standards on Nutrient Retention in the Tobacco Creek Watershed, Manitoba, Canada

Nutrient loading from agricultural drainage systems into downstream aquatic ecosystems, like Lake Winnipeg in the prairie province of Manitoba, Canada, represents a major challenge for water quality management. In order to improve water quality in downstream waterbodies, the Manitoba government is currently investigating the relationship between hydrological standard of agricultural drainage network and nutrient retention in the drainage systems. Briefly, oversized drains have more capacity to transport nutrients, which can increase nutrient loading to downstream waterbodies, especially during rainfall events. Currently, the hydrological standards of agricultural drainage design in Manitoba were mainly developed according to cost-benefit analysis without considering nutrient retention. The purpose of this study was to use computer modelling techniques to simulate the impact of drain size (based on different hydrological standards) on nutrient retention within an agricultural drainage network. The site chosen was the Tobacco Creek Watershed, an agricultural area which drains into the Red River, and thence into Lake Winnipeg. Suspended sediment, nutrient and flow data, from several locations along the Brown drain within this watershed, were used to calibrate a water quality model. Scenarios were then simulated with the model to estimate how different drain sizes affect nutrient transport and retention. Sampling took place during the spring and summer of 2013 starting with freshet and ending when the drains dried up near mid-summer. Study results indicated that the amount of nutrients transported was generally greater during freshet and summer rain storms. Occasionally, however, nutrients in summer discharge exceeded those transported during freshet. The water quality model was applied to the Brown drain to investigate the effects of different drain sizes for rainfall amounts under 2, 5, 10, 15, and 20 year return periods. Generally the results indicate that as the return periods became larger (in larger channels) lower nutrients concentrations were predicted downstream (higher decay rates). On average, the model predicted a 15%–20% decline in nutrient concentration with a 20-year return channel design compared to a 2-year return. The research from this study may provide an impetus to the policy-making process of drainage design.

Modelling Technique for the Assessment of the Sub-Soil Drain for Groundwater Seepage Remediation

Groundwater simulation technique was carried out for examining the performance of sub-soil drain at problematic site area. Subsoil drain was proposed as one of solution for groundwater seepage occurred at the slope face by reducing groundwater table at Taman Botani Park Kuala Lumpur. The simulation technique used Modular Three- Dimensional Finite Difference Groundwater Flow (MODFLOW) software. In transient conditions, the results of simulation showed that heads increases surpass 1 to 2 m from the elevation level of the slope area that caused groundwater seepage on slope face. This study attempt to decrease the heads increase surpass by using different sub-soil drain size in simulation technique. The sub-soil drain capable to decline the heads ranges of 1 to 2 m.

Novel Device For Removal of Blot Clot Obstructions in Drainage Tubes

Medical drains frequently become obstructed requiring removal or re-intervention. Currently, there is no widely accepted practice for maintaining drain patency. A simple device to remove obstructions from medical drains may have significant benefit. We manufactured a prototype drain clot extractor (DCE) for extracting obstructions. Fresh nonanticoagulated swine blood was instilled within drainage tubes of 16, 20, and 32 French (n = 2 for each size) to generate a 4 cm blood clot. The operator was then equipped with a 0.035 in. guidewire (GW) and given 2.5 min to attempt removal while blinded. Similarly, the operator was equipped with the DCE. Volumes removed were determined by volume displacement and by drain size and method of removal. Comparison of DCE to GW by analysis of variance and means comparison using Tukey were used for statistical analysis. The DCE facilitated mechanical removal of obstructions for 16, 20, and 32 French drainage tubes. Volumes removed: 16 French (GW mean 10% volume, DCE mean 70% volume p = 0.02); 20 French (GW mean 12.5% volume, DCE mean 75% volume p = 0.01); 32 French (GW mean 37.5% volume, DCE mean 100% volume p = 0.01). DCE volume removal had no dependence on drain size (p > 0.05). This device may have utility for reducing morbidity from early drain discontinuation or replacement. Further in vivo and clinical studies are needed to determine the safety, feasibility, and efficacy of this device as tool for removing medical drainage obstructions.

Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction: A cohort study.

In prosthesis-based breast reconstruction, drains are used to prevent seroma formation and to reduce the risk of infection. However, prolonged drainage increases the risk of ascending infection. Although the volume often accepted for drain removal is ≤30 mL per day, the optimal timing to remove the drain for best clinical outcome remains controversial.We did a retrospective cohort study of 569 patients of prosthesis-based breast reconstruction with infection rate as the outcome variable; drain duration and last daily drainage volume as the main independent variables. Data on age, smoking history, diabetes mellitus history, body mass index, breast weight, tissue expander size, drain size, number of retrieved lymph nodes, tumor size, number of metastatic lymph nodes, tumor stage, mastectomy type, reconstruction type, submuscular implantation, skin defect, operative time, duration of antibiotics use, chemotherapy, and radiotherapy were collected as covariates. Multivariable logistic regression analysis was used to control for confounding.The total infection rate was 5.1% (29/569). The daily drainage volume ≥30 mL/d at the time of drain removal was not found associated with increased infection rate (P = 0.32). Of the various cutoff values of last daily drainage volume, none was found to be a determinant for drain removal where the risk of infection was concerned. By contrast, drain duration over 21 days significantly increased infection rate (P = 0.001). The multivariable logistic regression analysis showed an increase of 76.2% in the infection rate with each additional week of drain retention (P = 0.001). Breast weight also had a significant influence on risk of infection. Chemotherapy and drain size showed borderline effect on risk of infection whereas the last daily drainage volume was not associated with risk of infectionIn summary, our study revealed that drain duration, rather than the last daily drainage volume, significantly affects the infection rate in prosthesis-based breast reconstruction. We recommend that the drain is better removed no longer than 3 weeks postoperatively and can be removed as early as postoperative day 7, even when the drainage is over 30 mL in a 24-hour period.

A Low Impact Approach to Infected Pancreatic Necrosis: Review of a Case Series.

Infected pancreatic necrosis develops in approximately one third of patients with necrotizing pancreatitis and can lead to significant morbidity and mortality rates. Historically, open necrosectomy has been the mainstay of management for these patients but is in itself a morbid procedure. In recent times, minimally invasive techniques have evolved to allow a less invasive approach to these patients. Percutaneous catheter drainage of infected pancreatic necrosis is a technique that has been demonstrated to be potentially useful in the treatment of this group of patients. The aim of this study was to review outcomes and define the technique of percutaneous catheter drainage in patients with infected pancreatic necrosis. All patients with infected pancreatic necrosis were exclusively treated with percutaneous drainage over the study period. Acute Physiology and Chronic Health Evaluation (APACHE) II score, number and size of drains, drainage technique and drain management, hospital and intensive care unit (ICU) stay, nutritional requirements, and morbidity and mortality data were evaluated for the patient group. Computed tomography (CT) scans were used to assess the progression of the disease process and the effectiveness of the treatment. There were nine patients with infected pancreatic necrosis in this case series between 2007 and 2012, all of whom were treated with percutaneous catheter drainage alone. The median APACHE II score in the patient group was 11, with a median stay in the ICU of 3 d and median hospital stay of 41 d. On average, nine CT scans were performed per patient during the hospital admission. A median of three drains were inserted per patient, and in the course of the study, it was evident that the larger drain size was the most effective. In eight of the nine patients in the group, complications developed that were both directly and indirectly related to the pancreatitis, but were effectively managed. There were no deaths. Percutaneous catheter drainage as a stand-alone intervention is an alternative strategy for infected pancreatic necrosis and can be used with acceptable morbidity and mortality rates in this challenging group of patients.

Effect of abdominopelvic abscess drain size on drainage time and probability of occlusion

BackgroundThe purpose of this study is to determine whether larger abdominopelvic abscess drains reduce the time required for abscess resolution or the probability of tube occlusion. Methods144 consecutive patients who underwent abscess drainage at a single institution were reviewed retrospectively. ResultsLarger initial drain size did not reduce drainage time, drain occlusion, or drain exchanges (P > .05). Subgroup analysis did not find any type of collection that benefitted from larger drains. A multivariate model predicting drainage time showed that large collections (>200 mL) required 16 days longer drainage time than small collections (<50 mL). Collections with a fistula to bowel required 17 days longer drainage time than collections without a fistula. Initial drain size and the viscosity of the fluid in the collection had no significant effect on drainage time in the multivariate model. Conclusions8 F drains are adequate for initial drainage of most serous and serosanguineous collections. 10 F drains are adequate for initial drainage of most purulent or bloody collections.

양치시설 설계 및 운영에 대한 관련 실무자의 견해: 초점집단면접 연구

This study collected opinions about the design and management of toothbrushing facilities from schoolteachers and the people in charge of public centers, through a focus group interview (FGI), for the development of guidelines. Four moderators conducted eight FGIs of 32 subjects in charge of toothbrushing facilities across all the regions. The qualitative data was analyzed by constant comparative analysis. The findings indicated that more students utilized the facility and brushed their teeth after the installation of toothbrushing facilities. To enhance students' accessibility and safety, guidelines for design and management guidelinesfor toothbrushing facilities need to be developed; the location, sink height and depth, drain size, etc. should be comprehensively considered in the development of the guidelines. This study can help to improve students' satisfaction by enhancing the accessibility, safety, and functionality of toothbrushing facilities, and by providing fundamental data for toothbrushing facilities' development. Finally, this study can maximize the effects of management of toothbrushing facilities management on the improvement of students' oral health and behaviors.

Physical Modeling on Hydraulic Performance of Rectangular Bridge Deck Drains

This paper presents results from an extensive experimental study on hydraulic performance of new rectangular bridge deck drains developed by the Texas Department of Transportation (TxDOT) Bridge Division. It fits between the deck reinforcement with the top of the drain flush with the bridge surface and does not interfere with the structural connection of the bridge rail to the deck. Experiments have been performed by varying drain sizes, the number of open drains in series, approach discharges, cross slopes and longitudinal slopes. Measurements include a series of approach gutter flow depth and ponding width at different stations along the deck, and weir heights for capture and bypass discharges. An accurate prediction model has been developed for the captured discharge. The model reveals that the capture discharge is a function of the drain size, the number of open drains, the Manning’s roughness coefficient, the depth of approach flow, the longitudinal slope, and the cross slope. The rating curve for each individual drain in series is the same when the drain size is 10 cm by 20 cm; however, it decreases slightly along the flow direction when the drain size is 15 cm by 20 cm.

Hydrologic Characterization of an Underdrained Porous Pavement

AbstractThe hydrologic behavior of an underdrained porous pavement system was characterized using an effective curve number (ECN), which is synonymous to the common runoff curve number (RCN). A model previously developed for porous pavements without an underdrain, which generates the rainfall-runoff data for the system, was modified to include an underdrain. However, the addition of an underdrain adds three new parameters (drain size, drain placement height, and drain spacing) that both influence the ECN and fundamentally change the design procedure. A sensitivity analysis was completed to quantify the impacts of different rainfall depths and distributions on this modified model. The RCN equations were then fit to the rainfall-runoff data to find the ECN value. ECN values for a wide range of pavement and underdrain configurations were summarized in figures that can be used as preliminary design aids for designers and regulators. These figures can be used to estimate the ECN value for a pavement design usi...

Image-guided Percutaneous Drainage for Treatment of Post-Surgical Anastomotic Leak in Patients with Crohn's Disease.

Anastomotic leaks with abscess formation are a common complication after bowel surgery in Crohn's disease patients. Image-guided percutaneous drainage is an attractive alternative to reoperation because of decreased morbidity and length of hospital stay. Because data for this specific population are scarce, the purpose of this study is to determine the safety and efficacy of image-guided percutaneous drainage in the management of post-surgical anastomotic leak in patients with Crohn's disease. A total of 41 patients who underwent percutaneous drain placement for the treatment of fluid collections due to anastomotic leak from September 2004 to November 2013 were retrospectively identified from the electronic medical record and picture archiving and communication system. Data recorded included number, size, and location of anastomotic leaks, number of drains placed, number of follow-up visits, post-drainage complications, abscess resolution, and subsequent surgeries. In all, 41 patients with 76 fluid collections were identified as having received percutaneous drains. The mean number of targeted fluid collections per patient was 1.5, and the mean duration between surgery and percutaneous drain placement was 18.5 days. The mean number of drains placed was 1.6, and the median drain size was 10 French [range 8-16 French]. One of 41 [2.4%] patients experienced a minor complication from drain placement [injury to a superficial abdominal artery] and no major complications occurred. Two of 41 [4.9%] patients required repeat surgeries. Image-guided percutaneous drainage for the treatment of post-surgical anastomotic leaks in Crohn's patients is effective and safe, with low rates of complications and reoperations.

Efficacy and safety of a protocol for early discharge in mild acute pancreatitis (MAP)

s / Pancreatology 15 (2015) S1eS141 S56 Patients & methods: We retrospectively identified patients with necrotizing pancreatitis from in-hospital databases (2004-2014) in four tertiary referral centers and included patients who underwent primary PCD for (suspected) infected necrosis. Results: In total 369/1427patients (26%)werediagnosedwithnecrotizing pancreatitis, of whom 117 patients (32%) underwent primary PCD for suspected infected necrosis. Infected necrosis was ultimately proven in 82 patients (70%). In theproactivePCD center42patients (36%)were treated versus 75 patients (64%) in the other centers, with a median of 3 PCD procedures (interquartile range (IQR) 2-4) and a 16Fr drain size (IQR 14-20) versus 2 PCD procedures (IQR 1-2) and a 14Fr drain (IQR 12-14) P<.001, respectively. In the proactive PCD center less patients required additional surgical necrosectomy, 29%vs.52%P1⁄4.045, and lessnewonsetorgan failure after PCDwas seen,5%vs. 20% P1⁄4.114. Mortality was comparable, 17% vs. 19% P1⁄4.787. Conclusion: A proactive PCD strategy for patients with (suspected) infected necrotizing pancreatitis appears to reduce the need for surgical necrosectomy. Future studies will have to demonstrate the true clinical value of this strategy.