The power of suction: Theory and practice in closed suction vs gravity drains and postoperative pancreatic fistulas

Jack O'Grady, Thomas L. Sutton, Kristin C. Potter, Erin Gilbert, Rodney Pommier, Skye C. Mayo, Brett C. Sheppard

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Postoperative pancreatic fistula (POPF) is a feared complication in pancreatic resection. Gravity drainage (GD) is hypothesized to reduce POPF versus closed-suction drainage (CSD). We sought to evaluate this theory. Methods: Six-hundred-twenty-nine patients undergoing pancreatic resection between 2013 and 2020 were analyzed with multivariable logistic regression for the outcomes of POPF and clinically-relevant POPF (crPOPF). Results: Three-hundred-ninety-seven patients (63.1%) underwent pancreaticoduodenectomy and 232 (36.9%) underwent distal pancreatectomy. Suction drains were placed in 588 patients (93.5%) whereas 41 (6.5%) had GDs. One-hundred-twenty-five (27.6%) experienced a POPF; 49 (10%) crPOPFs. On multivariable analysis, suction drainage was not associated with increased risk of POPF (OR 0.76, 95% CI 0.30–1.93, P = 0.57) or crPOPF (OR 0.99, 95% CI 0.30–3.26, P = 0.98). Conclusion: Suction drainage does not promote POPF when compared to GDs. Drain type should be determined by surgeon preference, while taking into account nursing and patient-specific considerations especially when patients are discharged with drains.

Original languageEnglish (US)
JournalAmerican journal of surgery
DOIs
StateAccepted/In press - 2022
Externally publishedYes

Keywords

  • Hepatobiliary
  • Pancreas Resection
  • Postoperative Pancreatic Fistula
  • Surgical Drain
  • Whipple

ASJC Scopus subject areas

  • Surgery

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