Intraperitoneal prophylactic drain after pancreaticoduodenectomy: an Italian survey

Abstract

Intraperitoneal prophylactic drain (IPD) use in pancreaticoduodenectomy (PD) is still controversial. A survey was designed to investigate surgeons' use of IPD in PD patients through 23 questions and one clinical vignette. For the clinical scenario, respondents were asked to report their regret of omission and commission regarding the use of IPD elicited on a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were applied. One hundred three (97.2%) respondents confirmed using at least two IPDs. The median regret due to the omission of IPD was 84 (67-100, IQR). The median regret due to the commission of IPD was 10 (3.5-20, IQR). The CR-POPF probability threshold at which drainage omission was the less regrettable choice was 3% (1-50, IQR). The threshold was lower for those surgeons who performed minimally invasive PD (P = 0.048), adopted late removal (P = 0.002), perceived FRS able to predict the risk (P = 0.006), and IPD able to avoid relaparotomy P = 0.036). Drain management policies after PD remain heterogeneous among surgeons. The regret model suggested that IPD omission could be performed in low-risk patients.

Keywords: Drainage; Pancreatectomy; Questionnaire; Regret; Survey.

Fig. 1

Box plots reporting regret of omission, commission, and CR-POPF threshold in the clinical vignette presented to the 106 respondents

Fig. 2

Percentage of responders who consider the IPD omission as the least regrettable choice based on the risk of CR-POPF. The x-axis represents the Fistula Risk Score categories (FRS); the blue line reports the risk of CR-POPF related to each category of FRS according to Trudeau et al. [22]; the orange line reports the percentage of responders who perceived the IPD omission as the least regrettable choice for the related risk of CR-POPF