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Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

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.

Oxford University Press (OUP)

A Sgrò R Blanco-Colino WUR Ahmed N Brindl RR Gujjuri P Lapolla EC Mills S Pérez-Ajates AS Soares C Varghese W Xu KA McLean SJ Chapman E Espín-Basany JC Glasbey A Mihaljevic D Nepogodiev F Pata G Pellino P Pockney NN Dudi-Venkata N Egoroff I Ludbrook K Raubenheimer T Richards P Pockney S Delibegovic M Salibasic T Amjad N Brindl C Dörr-Harim N Gedeon J Gsenger A Mihaljevic M Tachezy S Bini G Gallo A Gori P Lapolla F Pata G Pellino A Picciariello M Podda C Riboni MJ Machatschek A Nguyen M Jakubauskas M Kryzauskas T Poskus SZ Kuiper J Wang CI Wells IP Bissett KM Augestad I Steinholt AS Soares BN Vieira J Juloski O Anabitarte Bautista Y El Kasmy El Kasmy S Pérez-Ajates P Martín-Borregón M Ossola Revilla E Espín-Basany S Van Straten MK Aktas BE Baki WUR Ahmed M Akhbari D Baker S Bhatia S Brown W Cambridge SK Kamarajah RA Khaw O Kouli KA McLean EC Mills V Murray I Trout I Yasin Y Wong J H Reyhani KHF Wong R Pancharatnam WL Chia A Walmsley A Hassane D Saeed B Wang B Walters Z Nowinka A Alsaif M Mirza K Foster J Luu P Kakodkar JT Hughes T Yogarajah A Antypas A Rahman M Bradbury M McLarnon S Nagi AM Riad M Erotocritou H Kyriacou V Kaminskaite S Alfadhel Q Fatimah Hussain A Handa C Massy-Westropp S Čustović R Dimov H Mughal M Slavchev T Ivanov N Gouvas A Hegazi P Kocián MD Kjaer A Mark-Christensen D Papakonstantinou N Machairas T Triantafyllou Z Garoufalia D Korkolis A Castaldi A Picciariello S Giaccari G Spolverato G Pagano M Milone G Turri F Colombo E Cucinotta G Poillucci P Lapolla S Bini T Perra R Tutino F Belia D Coletta A Belli D Rega P Cianci G Pirozzolo M Di Lena F Perrone A Giani F Lovisetto M Grassia NS Pipitone Federico F Ferrara A Biancafarina N Tamini G Sinibaldi F Tuminello R Galleano D Sasia L Bragaglia A de Manzoni Garberini A Pesce F Cassaro P Venturelli A Gori GL Canu G Esposito M Campanelli R Cardia M Ricciardiello A Sagnotta G Canonico G De Marco A Cappiello E Pinotti F Carlei G Lisi G Bagaglini G Gallo A Nguyen MJ Machatschek M Farrugia EM Meima - van 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JJ Segura-Sampedro E Colás-Ruiz JL Blas Laina L Ponchietti P Buchwald E Gialamas V Ozben A Rencuzogullari İE Gecim Y Altinel O Isik T Yoldas A Isik S Leventoğlu MS Ertürk A Guner SA Güler W Attaallah M Ugur GS Özbalcı H Marzook N Eardley S Smolarek R Morgan C Roxburgh AK Lala Y Salama B Singh A Khanna M Evans I Shaikh K Maradi Thippeswamy B Appleton S Moug I Smith N Smart P Shah G Williams G Khera A Goede M Varcada C Parmar S Duff R Hargest P Marriott D Speake A Ben Sassi A Goede B Furfaro D Daudu N Golijanin WY Yek G Capasso LT Mansour N Niu W Seow A Hamidovic E Kulovic E Letic A Aljić E Letic M Helez A Banji-Kelan N Dimitrova P Kavradjieva V Ivanov A Jukaku D Hadzhiev H Mughal M Slavchev A Gabarski M Karamanliev P Vladova S Iliev T Yotsov Η Ευσταθίου K Vetsa N Gouvas O Stavrinidou P Papatheodorou T Liassides T Georgiou A Hegazi M Al Nassrallah R Altaf T Amjad M Negametzyanov T Dušek D Zagibová F Foltys H Štefanová A Paspala D Papakonstantinou G Bompetsi T Sidiropoulos GC Sotiropoulos N Machairas P Stamopoulos A Triantafyllou C Theodoropoulos A Kimpizi D Theodorou T Triantafyllou T Palyvou A Charalabopoulos A Syllaios D Schizas E Liatsou E Baili I Vagios N Tomara S Davakis D Balalis A Palumbo A Castaldi F Foroni A Picciariello DF Altomare R Dibra V Papagni A Urbani E Rossin G Nezi P Romano A Amendola E Esposito M Manigrasso P Anoldo S Vertaldi G Gecchele G Turri ZS Sabrina C Guerci F Cammarata GMB Lamperti G Zaffaroni L Benuzzi L Ferrario M Cigognini C Mazzeo G Badessi G Pintabona A Fassari A Mingoli B Cirillo C D’Alterio G Brachini M Tancredi M Zambon M Aulicino P Sapienza P Lapolla P Liberatore S Bini AM Scanu CF Feo T Perra A Iacomino M Massani P Pelizzo R Tutino S Rossi SA Vigna U Grossi V Grillo A Agnes CA Schena F Belia G Marincola A Oddi B Perotti D Coletta V Mario P Perri S Zazza A Aversano D Scala K Di Lauro M Leongito M Piccirillo R Patrone E Restini P Cianci S Capuzzolo C Vignotto G Pirozzolo QR Bao C Giuseppe E Angarano M Di Lena F Marino F Perrone F Pezzolla G Gigante C Magistro J Crippa M Maspero P Carnevali F Lovisetto R Trapani S Zonta L Agostinelli L Vittori L Romeo E Doria F Farnesi R Danna F Ferrara A Biancafarina E Andolfi GA Pellicano’ M Angelini M Scricciolo C Zanframundo C Ciulli L Ripamonti L Cigagna M Oldani N Tamini A Larcinese D Rossi E Picone G Crescentini F Tuminello G Caristo A Marano D Sasia M Migliore MC Giuffrida S Palagi V Testa A Borrello A Lucarini E Garofalo G Canali L Bragaglia P Orlandi A de Manzoni Garberini F Nervegna F Marchegiani I Damoli A Licata C Trovato F Cassaro F Alicata F Sardo M Milazzo B Randisi DM Dominici G Cocorullo P Venturelli A Gori L Sartarelli M Zanni A Pisanu C Soddu D Delogu E Erdas F Campus F Cappellacci F Casti G Esposito J Marcialis J Atzeni MG Podda B Sensi G Sica M Franceschilli M Campanelli V Bellato A Cannavera G Putzu N Cillara FF di Mola M Ricciardiello A Sagnotta B Picardi L Solinas M Loponte S Rossi del Monte S Rossi C Di Martino C Linari G Spagni L Capezzuoli L Tirloni T 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Fagarasan I Tulina M Khetagurova S Rodimov A Kapustina A Mekhralyzade M Zabiyaka J Juloski U Janković V Cuk A Panyko M Hájska M Dubovský M Hrošová N Ferancikova E Camarero Rodríguez F Laguna Alcántara J Adarraga C Jezieniecki M Ruiz Soriano T Gómez Sanz A Suarez C Sánchez García JM Marín Santos E Alonso Batanero I Cifrian Canales J Llosa Pérez M Merayo A Urbieta A Gegúndez Simón JF Tone J Gazo Martínez M Vicario Bravo N Chavarrias A Gil Catalán A Oseira B Villalonga C Soldevila Verdeguer S Jeri E Colás-Ruiz J Perez Calvo A Nogués B Cros C Yánez I Talal El-Abur JL Blas Laina A Utrilla Fornals M Roldón Golet M García Domínguez P Colsa T Gimenez Maurel M Delorme P Buchwald T Axmarker E Gialamas M Chevallay TV Pham BB Ozmen EK Sel V Ozben C Atar MK Aktas M Aba BB Ozkan M Sarkin YM Akkaya AG Durmaz F Calikoglu HF Gullu A Boğa A Aktaş B Bakar MT Demirel S Kural X Hysejni F Zafer M Taser OR Guzel O Bozbiyik A Isik D Özen M Ölmez Y Kaya B Uyar E Gülçek GS Kayacan N Atıcı OF Gul S Altiner B Ibis S Altunsu T Banaz C Diler I Demirbas MA Usta O Erkul R Orman S Salih NZ Utkan OC Tatar SA Güler C Acil E Ozgur M Maddahali AB Turhan AB Eskici B Ular M Doğru OU Öztürk ER Arslan A Panahi Sharif D Hurmuzlu E Dikmen J Ates R Bircan T Cavus AE Sever B Balak E Duman K Korkmaz L Altay O Emanet F Cullen JY Tan P Sharma A Nathan A Rottenberg CY Williams CG Mitrofan D Xu JH Bawa P Morris R Troller D Gordon G Richmond JC Hui N Hagan O Ighomereho R Rocks S McCabe A Fitzpatrick J Mooney J Nicoletti JC Hui L Auterson N Darrah VWY Soh A Light CS Ong M Utukuri C Gallagher LM Stuart M Hipolito N Douglas R Ghazal G Parris J Catchpole M Tansey M Bryden S Jamal Z Karim C Lyon-Dean D Bhojwani G Rowley KS Lee O Whitehurst A Mirza F Sheikh H Yousaf J Bilbao R Sinclair S Takar H Kressel RM McGing V Chan A Mallon K Schack R Osborne S Baldemor S Smyth S Gilmour A Ting I Bozonelou P Saunders QA Qhaireel Anwar R Tirimanna S Jauhari A Gardener B Walker C Spilsbury C Wenban H Reddy R Conway-Jones S Loganathan A Clynch C James E Matey F Cameron R James W Roberts A Gicquel C Milliken J Forbes P Rubinchik S O’Brien A Isaac A Azmi C Hawkes L Cornett P Adarkwah R McConville S O'Hara C Tijare J Parkes L Yao R Ahmad S Balasubramanya U Shafiq A Mhaisalkar A Gurung H Sadik K de Stadler S Elias T Thomas A Madras A Jani HK Daler KS Tong SS Sundaralingam Z Nowinka A Szal A Khan C O'Sullivan E Baker J Joseph-Gubral T Gala JY Chen B Turner E Hadley R Trivedi E Igwelaezoh E Goh H Barton W Allison W Hurst F Alam I Parkes K Hassan M Jamshaid N Azizan T Burgher A Afzal I Eltilib M Zahid O Sadiq A Lloyd P Mason R Ho A Brazukas CH Li M Kamdar MN Mohamed Nazeer N Tzoumas A Mighiu D Kim L Wilkins L Kuo R Conway-Jones T Rafe T Noton D Maduka H Cheema K Farag M Mirza M Abdellatif R Nzewi A Kruczynska H Grasselli M Yousuff N Ahmed R Bassi AK Mann J Chopra M Shaikh P Sharma S D Sa V Tsimplis A Ghanchi E Skene K Asim M Zaheer S Chan H Dalton K Gibbons O Adderley I Chukwujindu I Jayasuriya K Sivanu M Borumand SK Bylapudi G Chick I Bridges J Tomlin J McKenna N Nandra N Grace C Grieco FF Quek R Mercer S Latif T Brankin-Frisby A Sattar A Aslam E Edelsten S Shafi T Kouli V Ford F Gurung JS Kiam M Fernandes N Deader R Ponniah S Jamieson A Davies J Taubwurcel MT Aung R Desai S Begum T Jamadar A Kangatharan B Rzeszowski C Ho SHK Yap M Prendergast R Sethi A Duku C Lowe J Bray K Elsamani M Ghobrial V Nichita A Wagstaff C Hughes E Rengasamy F Abu Hassan H Mahmood N Savill S Shah T Almeida LOH Sinan A Edwards A Antypas B Catchpole D El-Dalil Z Halford A Carmichael EJM Khoo H Alsusa EE Salim M Boyd C Reid D Stark J Williams J Feyi-Waboso M Patel Z Zeidan E Bailey J Bapty M Brazkiewicz N Minhas A Tremlett G Fowler H Pringle S Mankal V Kaminskaite W Chung E Rees E Parry-Jones K Anderson A Mcforrester A Stanley A Hoather H Wise I Laid I Giudiceandrea J Scriven A Braniste A Wilson L Le Blevec N Pakunwanich N Evans HL Chong C White J Hunter M Haque P Vanalia S Murdoch T Choudhary A McCann A Harun H 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Lovett A Kinčius S Hussein E Kirby RG Beckett J Salmon A Rafie T Glynn SY Choo S Lyons D Browne W Ravindran S Ahmad M Erotocritou X Zhu M Erotocritou M Bradbury J McNulty L McCarthy J Ng Z Karmally K McTeir M Hanna E Tan S Namdeo R Schembri E Pusey

British Journal of Surgery

2022

Title: Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Description:

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.

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.

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Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

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