Benjamin Clapp, MD, Robert Cullen, BS, Ira L Swinney, MS, Alan Tyroch, MD, Ellen Wicker, DO, Ginger Coleman, MD, Calvin Mcnelly, BS, Babak Sadri, BS, Carlos Lodeiro, BS, Chris Dodoo, MS. Texas Tech HSC Paul Foster School of Medicine
Introduction: Laparoscopic gastric bypasses (GB) and sleeve gastrectomies (SG) are the two most common bariatric operations. There have been changes in surgical technique and surgical norms over time. The main advance has been moving towards laparoscopic surgery. With the implementation of enhanced recovery protocols, surgeons tend to use less invasive methods of perioperative management. This includes decrease in foley catheterization, the use of nasogastric tubes and drains. There is still controversy about the use of drains and indications for drain placement. As practice patterns change and enhanced recovery protocols are adopted, the use of drains should decrease.
Methods: The MBSAQIP database was queried for the years 2015 and 2016. Our inclusion criteria included all patients undergoing a primary GB or SG. Revisions were excluded. We examined demographics, operative characteristics, the use of drains, and post operative complications. Continuous variables were summarized using mean and standard deviations (SD). Categorical variables were summarized using frequencies and proportions. Students T- test (Wilcoxon sum rank test in the case of skewed data) and chi-squared analysis was used to assess the baseline differences in drain utilization. To assess the factors that predict drainage usage, the generalized linear models with family Poisson and link log was used obtain the relative risk measures. P values <5 % were considered statistically significant. All analyses were carried out using STATA V15.
Results: In 2015-2016 there were 240,462 bariatric cases performed without drains and 70,292 with drains. 31.4% of GB patients had a drain placed but only 18.5% of SG patients. The percentage of GB that had a drain dropped from 33.1% to 29.7% during the study period and SG dropped from 20.3% to 17.0%. For GB and SG, there was no difference in provocative testing, swallow studies, operative length, reoperations, readmissions or death. Patients that had drains placed were more likely to have a provocative test at the time of surgery (relative risk (RR) 1.9) and to have a postoperative swallow study (RR 2.67).
Conclusions: Drains are still commonly used in bariatric patients. Over the study period, there was a slight decrease in the use of drains in both bypass and sleeve patients. Patients with a drain were more likely to have had a provocative test and a swallow study. Drain placement was not associated with higher complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92360
Program Number: P195
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster