Terumasa Yamada1,2, Kunihito Gotoh3, Shigeru Marubashi3, Tadafumi Asaoka4, Atsushi Miyamoto5, Shogo Kobayashi3, Hidetoshi Eguchi4, Junzo Shimizu6, Yongkook Kim7, Masanori Tsujie8, Takehiro Noda9, Shigekazu Yokoyama10, Yutaka Takeda11, Masaki Mori4, Yuichiro Doki4, Hiroaki Nagano4. 1. Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan. yamada-t@higashiosaka-hosp.jp. 2. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. yamada-t@higashiosaka-hosp.jp. 3. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. 4. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan. 5. Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan. 6. Department of Surgery, Osaka Rosai Hospital, Sakai, Japan. 7. Department of Surgery, Kaizuka City Hospital, Kaizuka, Japan. 8. Department of Surgery, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan. 9. Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan. 10. Department of Surgery, Yao Municipal Hospital, Yao, Japan. 11. Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan.
Abstract
BACKGROUND: Adverse events (AEs) after hepatectomy (Hx) have decreased. The aim of this study was to assess the safety of Hx and to identify the risks and benefits of drain insertion. METHODS: From 2010 to 2012, a multicenter, prospective cohort study was conducted in consecutive patients who underwent Hx. Patients who were scheduled to undergo Hx with neither reconstruction of the biliary tract nor concomitant resection of other organs were excluded. AEs were graded based on the Clavien-Dindo classification. Univariate analysis was performed to identify the risks and benefits in all cases and in selected cases matched by propensity score. RESULTS: This study included 197 patients. AEs occurred in 20 (10.1%). In all cases, no difference in the rate of AE was observed between those with and without drain insertion. Postoperative hospital stay in the group with drains (n = 132) was statistically longer than that in the group without drains (n = 65) (17.7 vs. 11.5 days, P = 0.001). In patients without AE (n = 177), hospital stay in the group with drains was statistically longer than that in the group without drains (14.1 vs. 11.3 days, P < 0.001). In propensity score-matched cases (41 cases in each group), postoperative hospital stay in the group with drains was also statistically longer than that in the group without drains (17.3 vs. 11.4 days, P = 0.003). CONCLUSION: Drain insertion after hepatectomy may lead to longer hospital stay in patients with and without AE.
BACKGROUND: Adverse events (AEs) after hepatectomy (Hx) have decreased. The aim of this study was to assess the safety of Hx and to identify the risks and benefits of drain insertion. METHODS: From 2010 to 2012, a multicenter, prospective cohort study was conducted in consecutive patients who underwent Hx. Patients who were scheduled to undergo Hx with neither reconstruction of the biliary tract nor concomitant resection of other organs were excluded. AEs were graded based on the Clavien-Dindo classification. Univariate analysis was performed to identify the risks and benefits in all cases and in selected cases matched by propensity score. RESULTS: This study included 197 patients. AEs occurred in 20 (10.1%). In all cases, no difference in the rate of AE was observed between those with and without drain insertion. Postoperative hospital stay in the group with drains (n = 132) was statistically longer than that in the group without drains (n = 65) (17.7 vs. 11.5 days, P = 0.001). In patients without AE (n = 177), hospital stay in the group with drains was statistically longer than that in the group without drains (14.1 vs. 11.3 days, P < 0.001). In propensity score-matched cases (41 cases in each group), postoperative hospital stay in the group with drains was also statistically longer than that in the group without drains (17.3 vs. 11.4 days, P = 0.003). CONCLUSION: Drain insertion after hepatectomy may lead to longer hospital stay in patients with and without AE.
Authors: Omar Hyder; Carlo Pulitano; Amin Firoozmand; Rebecca Dodson; Christopher L Wolfgang; Michael A Choti; Luca Aldrighetti; Timothy M Pawlik Journal: J Am Coll Surg Date: 2013-03-09 Impact factor: 6.113