Drain Placement After Pancreatic Resection: Friend or Foe For Surgical Site Infections?

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Infectious Disease

Background:

• Controversy exists regarding the necessity and duration of drain placement after pancreatectomy.
• Previous studies and trials have not definitively resolved optimal drain management strategies.

Purpose of the Study:

• To investigate the association between post-pancreatectomy drain placement and timing of removal with infectious outcomes.
• To identify specific pancreatic resection procedures and infectious sites most at risk.

Main Methods:

• Retrospective cohort analysis of 39,057 patients undergoing pancreatectomy between 2015-2020 from the ACS-NSQIP database.
• Propensity score matching was used to analyze the relationship between drain placement and surgical site infections (SSI).

Main Results:

• Drain placement did not significantly lower superficial or organ/space SSI rates after proximal pancreatectomy.
• Drain placement was associated with higher organ/space SSI rates after distal pancreatectomy (12% vs 9%, p=0.010).
• Drain removal on or after postoperative day 3 correlated with increased SSI rates for both proximal and distal pancreatectomies.

Conclusions:

• Drain placement increases organ/space SSI risk after distal pancreatectomy but not pancreaticoduodenectomy.
• Early drain removal (before postoperative day 3) is associated with reduced SSI rates across all pancreatectomy types.
• Selective drain use for high-risk cases or distal pancreatectomies, coupled with early removal, may mitigate SSI concerns.