Early drain removal after hepatectomy: an underutilized management strategy

Area of Science:

• Hepatobiliary surgery
• Surgical outcomes research
• Abdominal surgery

Background:

• Routine surgical drains after hepatectomy are common despite evidence suggesting they may be unnecessary.
• A discrepancy exists between current practice and emerging data on drain management post-hepatectomy.

Purpose of the Study:

• To compare patient outcomes following early versus routine drain removal after hepatectomy.
• To evaluate the impact of drain removal timing on morbidity, bile leaks, length of stay, and readmissions.

Main Methods:

• Utilized the 2014-2016 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
• Included patients undergoing major (≥3 segments) or partial (≤2 segments) hepatectomy with drain placement.
• Employed propensity score matching to compare early (postoperative day 0-3) and routine (POD 4-7) drain removal groups.

Main Results:

• Early drain removal was associated with significantly lower overall morbidity (12% vs 19%) and serious morbidity (9% vs 13%).
• Patients with early drain removal experienced fewer bile leaks (2.1% vs 5.0%) and a shorter hospital stay (4 vs 6 days).
• Readmission rates were also lower in the early drain removal group (5.4% vs 8.1%).

Conclusions:

• Early drain removal following hepatectomy is linked to reduced complications, shorter hospital stays, and fewer readmissions.
• Implementing early drain removal represents an underutilized strategy to improve patient recovery after liver surgery.