Arielle E Kanters, MD, MS, Sarah P Shubeck, MD, Justin B Dimick, MD, MPH, Dana A Telem, MD, MPH. University of Michigan
Introduction: The use of closed suction drains is associated with poor outcomes in many anastomotic operations and routine use is not recommended. In this context, intraoperative drain placement for primary bariatric surgery remains controversial. Recent studies demonstrate that drains confer no benefit to patients; however, data are limited to descriptive single center experiences with low sample size. In order to characterize this practice gap, and implement evidence based recommendations, we sought to evaluate the use of closed suction drain and outcomes following primary bariatric cases using the MBSAQIP registry.
Methods: We used data from the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) public use file for patients who underwent a non-revisional laparoscopic roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), or laparoscopic adjustable gastric banding (LAGB). We excluded patients with ASA status greater than 3 or conversion to an open procedure. We analyzed demographics, preoperative comorbidities, procedure type for patients who did and did not undergo drain placement. Adjusted rates of postoperative complications and mortality were then compared based on receipt of postoperative drain placement.
Results: Of the 141,404 included patients who underwent laparoscopic bariatric surgery, 33,618 (23.8%) underwent intraoperative drain placement. Drains were more often placed in patients who underwent LRYGB, were older, had higher preoperative BMI, had higher preoperative ASA status, and had more comorbid conditions. After patient level risk adjustment, there was no difference in rates of leaks requiring intervention (0.32% versus 0.26%, p=0.065) or mortality (6.5% versus 5.4%, p=0.206) for patients with and without drains. In patients who underwent drain placement, there were higher rates of transfusion (9.2% versus 5.6%, p<0.001), reoperations for bleeding (0.30% versus 0.18%, p=0.001), all reoperations (4.8% versus 3.9%, p<0.001), and surgical site infections (SSI) (1.0% versus 0.6%, p<0.001).
Conclusion: Our analysis demonstrates that nearly one quarter of all laparoscopic bariatric surgery patients undergo drain placement. We found that drain placement is more common in preoperatively higher risk patients and following higher complexity procedures as suggested by associated increased rates of transfusion and reoperations for bleeding. We found no benefit to drain placement in terms of interventions for clinically significant leaks or mortality. Finally, patients who underwent drain placement were more likely to develop SSI suggesting routine placement is not without risk. Although further prospective studies are warranted, our analysis demonstrates that drains have the potential for harm with minimal protective benefit for patients after primary bariatric surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88314
Program Number: P633
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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