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Extended Experience with a Dynamic, Data-Driven Selective Drain Management Protocol in Pancreaticoduodenectomy: Progressive Risk Stratification for Better Practice by Trudeau, Maxwell T.; Maggino, Laura; Chen, Bofeng; McMillan, Matthew T.; Lee, Major K.; Roses, Robert; DeMatteo, Ronald; Drebin, Jeffrey A.; Vollmer, Charles M. is a Medicine article available to read on EtoBox.

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## Background: Intraoperative drain use for pancreaticoduodenectomy has been practiced in an unconditional, binary manner (placement/no placement). alternatively, dynamic drain management has been introduced, incorporating the fistula risk score (frs) and drain fluid amylase (dfa) analysis, to mitigate clinically relevant postoperative pancreatic fistula (cr-popf). ## Study design: An extended experience with dynamic drain management was used at a single institution for 400 consecutive pancreaticoduodenectomies (2014 to 2019). this protocol consists of the following: drains omitted for negligible/low-risk frs (0 to 2) and drains placed for moderate/high-risk frs (3 to 10) with early (postoperative day [pod] 3) removal if pod1 dfa ≤5,000 u/l. adherence to this protocol was prospectively annotated and outcomes were retrospectively analyzed. ## Results: The overall cr-popf rate was 8.7%, with none occurring in the negligible/low-risk cases. moderate/high-risk patients manifested an 11.9% cr-popf rate (n = 35 of 293), which was lower on-protocol (9.5% vs 21%; p = 0.014). after drain placement, pod1 dfa ≥5,000 u/l was a better predictor of cr-popf than frs (odds ratio 14.7; 95% ci, 4.3

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Author

Trudeau, Maxwell T.; Maggino, Laura; Chen, Bofeng; McMillan, Matthew T.; Lee, Major K.; Roses, Robert; DeMatteo, Ronald; Drebin, Jeffrey A.; Vollmer, Charles M.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Published

2020

Language

EN

Field

Medicine (Health Sciences)