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. 2024 Jan 3;8(1):zrad107.
doi: 10.1093/bjsopen/zrad107.

Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort

Stefano Guadagni  1 , Marco Catarci  2   3 , Francesco Masedu  4 , Mohammad Ehsanul Karim  5   6 , Marco Clementi  1 , Giacomo Ruffo  7 , Massimo Giuseppe Viola  8 , Felice Borghi  9   10 , Gianandrea Baldazzi  11   12 , Marco Scatizzi  13 , Felice Pirozzi  14 , Paolo Delrio  15 , Gianluca Garulli  16 , Pierluigi Marini  17 , Roberto Campagnacci  18 , Raffaele De Luca  19 , Ferdinando Ficari  20 , Giuseppe Sica  21 , Stefano Scabini  22 , Andrea Liverani  23 , Marco Caricato  24 , Alberto Patriti  25 ; Italian ColoRectal Anastomotic Leakage (iCral) study group
Collaborators, Affiliations

Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort

Stefano Guadagni et al. BJS Open. .

Abstract

Background: In Italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. The aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery.

Methods: A database was retrospectively analysed through a 1:1 propensity score-matching model including 21 covariates. The primary endpoint was the postoperative duration of stay, and the secondary endpoints were surgical site infections, infectious morbidity rate defined as surgical site infections plus pulmonary infections plus urinary infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation and mortality rates. The results of multiple logistic regression analyses were presented as odds ratios (OR) and 95 per cent c.i.

Results: A total of 6157 patients were analysed to produce two well-balanced groups of 1802 patients: group (A), no abdominal drain(s) and group (B), abdominal drain(s). Group A versus group B showed a significantly lower risk of postoperative duration of stay >6 days (OR 0.60; 95 per cent c.i. 0.51-0.70; P < 0.001). A mean postoperative duration of stay difference of 0.86 days was detected between groups. No difference was recorded between the two groups for all the other endpoints.

Conclusion: This study confirms that placement of abdominal drain(s) after elective colorectal surgery is associated with a non-clinically significant longer (0.86 days) postoperative duration of stay but has no impact on any other secondary outcomes, confirming that abdominal drains should not be used routinely in colorectal surgery.

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Figures

Fig. 1
Fig. 1
Study flow chart according to the reporting and guidelines in propensity score analysis iCral, Italian ColoRectal Anastomotic Leakage study group; ERAS, enhanced recovery after surgery; SMD, standardized mean difference.
Fig. 2
Fig. 2
Love plot of covariate standardized mean differences between treatment and control groups before and after matching; the vertical lines represent the interval of ± 0.1 within which balance is considered acceptable ERAS, enhanced recovery after surgery.
See this image and copyright information in PMC

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