Variation in Drain Management Among Patients Undergoing Major Hepatectomy.
BACKGROUND
Although previous studies have suggested that drain management is highly variable, data on drain placement and timing of drain removal among patients undergoing hepatic resection remain scarce. The objective of the current study was to define the utilization of drain placement among patients undergoing major hepatic resection.


METHODS
The ACS NSQIP-targeted hepatectomy database was used to identify patients who underwent major hepatectomy between 2014 and 2017. Association between day of drain removal, timing of discharge, and drain fluid bilirubin on postoperative day (POD) 3 (DFB-3) was assessed. Propensity score matching (PSM) was used to compare outcomes of patients with a drain removed before and after POD 3.


RESULTS
Among 5330 patients, most patients had an abdominal drain placed at the time of hepatic resection (n = 3075, 57.7%). Of 2495 patients with data on timing of drain removal, only 380 patients (15.2%) had their drain removed by POD 3. Almost 1 in 6 patients (n = 441, 17.7%) were discharged home with the drain in place. DFB-3 values correlated poorly with POD of drain removal (R2 = 0.0049). After PSM, early drain removal (≤ POD 3) was associated with lower rates of grade B or C bile leakage (2.1% vs. 7.1%, p = 0.008) and prolonged length of hospital stay (6.0% vs. 12.7%, p = 0.009) compared with delayed drain removal (> POD 3).


CONCLUSIONS
Roughly 3 in 5 patients had a drain placed at the time of major hepatectomy and only 1 in 7 patients had the drain removed early. This study demonstrated the potential benefits of early drain removal in an effort to improve the quality of care following major hepatectomy.
['Sahara|Kota|K|', 'Tsilimigras|Diamantis I|DI|', 'Moro|Amika|A|', 'Mehta|Rittal|R|', 'Hyer|J Madison|JM|', 'Paredes|Anghela Z|AZ|', 'Beane|Joal D|JD|', 'Endo|Itaru|I|', 'Pawlik|Timothy M|TM|']
D020878:Device Removal D004322:Drainage D006498:Hepatectomy D006801:Humans D008113:Liver Neoplasms D011183:Postoperative Complications D057216:Propensity Score
Drain Management Hepatectomy Early removal NSQIP