Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study
EuroSurg Collaborative, A Sgrò, Ruth Blanco‐Colino, WUR Ahmed, N Brindl, RR Gujjuri, P Lapolla, EC Mills, S Pérez-Ajates, AS Soares, Chris Varghese, William Xu, Kenneth A McLean, SJ Chapman, Eloy Espín, James Glasbey, André L. Mihaljević, Dmitri Nepogodiev, Francesco Pata, Gianluca Pellino, Peter Pockney, Nagendra N. Dudi‐Venkata, N Egoroff, Isabella Ludbrook, Kyle Raubenheimer, Toby Richards, Peter Pockney, S Delibegovic, Mirhan Salibasic, T Amjad, N Brindl, Colette Dörr-Harim, Naomi Gedeon, Julia Gsenger, André L. Mihaljević, Michael Tachezy, Simone Bini, Gaetano Gallo, A Gori, P Lapolla, Francesco Pata, Gianluca Pellino, Arcangelo Picciariello, M Podda, Cristiana Riboni, MJ Machatschek, Anh Nguyen, Matas Jakubauskas, Marius Kryžauskas, Tomas Poškus, SZ Kuiper, Jin Wang, CI Wells, IP Bissett, KM Augestad, Ingeborg Steinholt, AS Soares, BN Vieira, Jovan Juloski, O Anabitarte Bautista, Y El Kasmy El Kasmy, S Pérez-Ajates, Paula Martín-Borregón, Marián Revilla, Eloy Espín, Stephanie Van Straten, MK Aktas, BE Baki, WUR Ahmed, Melika Akhbari, Daniel Baker, Sanchita Bhatia, Steven R. Brown, William Cambridge, Sivesh K. Kamarajah, RA Khaw, Omar Kouli, Kenneth A McLean, EC Mills, Victoria Murray, Isobel M Trout, Ifat Yasin, Y. J., H Reyhani, KHF Wong, R Pancharatnam, WL Chia, A. D. Walmsley, A Hassane, D Saeed, B Wang, B Walters, Z Nowinka, Abdulaziz Alsaif, Mehdi Ali Mirza, Katharine Foster, J. Luu, Pramath Kakodkar, JT Hughes, Thinesshwary Yogarajah
Abstract
BACKGROUND: Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. METHODS: COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. RESULTS: Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). CONCLUSION: Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk.