Routine Use of Abdominal Drains in Colorectal Surgery May Not Be Necessary: Study

Colorectal surgery is a common procedure for treating various diseases of the colon and rectum. Postoperative management strategies, including the use of abdominal drains, aim to prevent complications and improve patient outcomes. In Italy, surgeons continue to drain the abdominal cavity in more than half of the patients after colorectal resection. This study aimed to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery.

A retrospective analysis was conducted using a database with 21 covariates. A 1:1 propensity score-matching model was employed to create two well-balanced groups of 1802 patients each. Group A consisted of patients who did not receive abdominal drains, while Group B included those who received abdominal drains.

The primary endpoint was the postoperative duration of stay. Secondary endpoints included surgical site infections, infectious morbidity rate (a composite measure of surgical site, pulmonary, and urinary infections), anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation, and mortality rates. The results were presented as odds ratios (ORs) and 95% confidence intervals (CIs).

The key findings of the study were:

• Patients in Group A (no abdominal drains) had a significantly lower risk of postoperative duration of stay longer than 6 days (OR 0.60; 95% CI 0.51–0.70; P < 0.001).

• The mean postoperative duration of stay was 0.86 days shorter in Group A compared to Group B.

• No significant differences were found between the two groups in terms of all secondary endpoints, including surgical site infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation, and mortality rates.

The study suggests that abdominal drain placement after elective colorectal surgery is associated with a slightly longer postoperative hospital stay but does not provide any additional benefit in terms of reducing complications. The findings challenge the routine use of abdominal drains in colorectal surgery, highlighting the potential for shorter hospital stays and resource savings without compromising patient safety.

This study confirms that the routine use of abdominal drains after elective colorectal surgery should be reconsidered, as it may lead to a non-clinically significant increase in postoperative hospital stay without any significant impact on other postoperative complications.

Reference:

Guadagni, S., Catarci, M., Masedu, F., Karim, M. E., Clementi, M., Ruffo, G., Viola, M. G., Borghi, F., Baldazzi, G., Scatizzi, M., Pirozzi, F., Delrio, P., Garulli, G., Marini, P., Campagnacci, R., De Luca, R., Ficari, F., Sica, G., Scabini, S., … the Italian ColoRectal Anastomotic Leakage (iCral) study group. (2024). Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort. BJS Open, 8(1). https://doi.org/10.1093/bjsopen/zrad107