Intraperitoneal drain placement prolongs hospital stay and increases surgical site infection risk

Delhi: Placement of an intraperitoneal drain following elective colorectal surgery does not result in earlier detection of postoperative collections, but it can lengthen hospital stay and increase the risk of surgical site infections (SSIs), says an article published in the British Journal of Surgery.

After elective colorectal surgery, many surgeons regularly insert intraperitoneal drains. However, due to a lack of demonstrated therapeutic effect, accelerated recovery after surgical recommendations advise against their habitual usage. As a result, EuroSurg Collaborative undertook this study to describe international diversity in intraperitoneal drain placement and its safety.

COMPASS (COMPlicAted intra-abdominal collectionS after colorectal surgery) was a prospective multinational study that included consecutive persons after elective colorectal surgery (February to March 2020). The rate of intraperitoneal drain implantation was the primary result. Secondary outcomes were the rate and time to diagnosis of postoperative intraperitoneal collections, the incidence of surgical site infections (SSIs), the time to discharge, and the 30-day significant postoperative sequelae (Clavien–Dindo grade at least III). Multivariable logistic regression and Cox proportional hazards regression were performed after propensity score matching to evaluate the independent relationship of secondary outcomes with drain placement.

The key findings of this study were as follows:

1. In all, 1805 patients from 22 countries were involved in the study (798 women, 44.2%; median age of 67.0 years).

2. The rate of drain placement was 51.9% (937 patients).

3. Drains were not related to lower rates or quicker identification of collections after matching.

4. Although drains were not linked to worse severe postoperative complications, they were linked to delayed hospital release and an increased risk of SSIs.

In conclusion, despite strong evidence and ERAS guidelines, this large multicenter, worldwide, prospective cohort research demonstrated that intraperitoneal drain placement is a widespread practice in elective colorectal surgery across the world. Surgeons should ensure that any drain implanted is expressly advised in the absence of unequivocal evidence of therapeutic benefit but evidence of possible damage to patients (with the rationale documented). Concerning the use of intraperitoneal drain implantation in elective colorectal surgery, de-implementation methods at the organizational and surgeon levels should be explored.

Reference:

Sgrò, A., Blanco-Colino, R., Ahmed, W., Brindl, N., Gujjuri, R., Lapolla, P., Mills, E., Pérez-Ajates, S., Soares, A., Varghese, C., Xu, W., McLean, K., Chapman, S., … Pusey, E. (2022). Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study. In British Journal of Surgery (Vol. 109, Issue 6, pp. 520–529). Oxford University Press (OUP). https://doi.org/10.1093/bjs/znac069