Intraperitoneal drain placement and outcomes after elective colorectal surgery: International matched, prospective, cohort study

Sgro, A; Blanco-Colino, R; Xu, W; Mughal, H; Valnarov-Boulter, A; Kayran, J; Banerjee, M; Parekh-Hill, N; Hooper, A; Bowen, J; Jagdish, R; Mcquoid, C; Khan, N; Hare, OR; Slavchev, M; Jeffery, S; Zahid, A; Elsworth, C; Walter, L; Dhillon, S; Rao, S; Anthony, A; Ashaye, A; Phillips, N; Faderani, R; Ivanov, T; Pengelly, S; Choi, S; Kwak, SY; Lau, YHL; Bagheri, K; Ong, DYC; Kerr, E; Falconer, K; Clancy, N; Douglas, S; Gouvas, N; Zhang, Y; Greenfield, F; Mutanga, I; McAlinden, J; Willis, L; Adefolaju, A; Agarwal, H; Barter, R; Harris, G; Spencer, G; Hegazi, A; Lee, MW; Vadiveloo, VT; Herbert, G; Patel, R; Shah, M; El Falaha, S; Wong, C; Soare, C; Akram, J; Bozhkova, L; Kocian, P; Ma, Y; Vo, UG; Tan, HWN; Leto, L; Kamal, MA; Hadzhieva, E; Krastev, P; Tonchev, P; Kokkinos, G; Pozotou, I; Kjaer, MD; Sabbagh, D; Votava, J; St, F; Koliakos, N; Tsaparas, P; Zografos, G; Mantas, D; Tsourouflis, G; Fradelos, E; Trigiante, G; Mark-Christensen, A; Labellarte, G; Resta, G; Capelli, G; Verlingieri, V; Campagnaro, T; Maffioli, A; Viscosi, F; De Lucia, C; Meneghini, S; Fancellu, A; Papakonstantinou, D; Colella, M; Biondi, A; De Peppo, V; Pace, U; Albino, V; Gattulli, D; Piangerelli, A; Kalivaci, D; Sisto, G; Mazzola, M; Machairas, N; Caneparo, A; Lunghi, EG; Nespoli, LC; Angrisani, M; Langone, A; Gelarda, E; Virgilio, E; Angelini, E; Fornasier, C; Asero, S; McLean, KA; Triantafyllou, T; Filippone, E; Frongia, F; Calo, PG; Panaccio, P; Ipponi, P; Gili, S; Braccio, B; Tiesi, V; Stolcers, K; Kokaine, L; Garoufalia, Z; Novikovs, V; Capel, L; Bastiaenen, V; Heijmans, H; Henriques, S; Gan, SZ; Ramanayake, H; Nolan, M; Temperley, H; Ciofic, E; Korkolis, D; Pop, BA; Kurtenkov, M; Vician, M; Arias, EP; de Heredia, BJ; Martinez, LM; Alvarez, DS; Alvarez-Gallego, M; Artigas, RJM; Dwidar, O; Castaldi, A; Korkmaz, HK; Eray, IC; Meric, S; Aydin, R; Cetin, B; Karaca, BE; Kuyumcu, OF; Yuksel, E; Uprak, TK; Karabulut, K; Giaccari, S; Kavukcu, E; Mansor, A; Hackett, R; Zammit-Maempel, M; Sabaratnam, R; Maan, A; Ferarrio, I; Dixon, L; Halai, H; Sethi, S; Spolverato, G; Nelson, L; Grassam-rowe, A; Krishnan, E; Deeny, D; McKeever, M; Pandeth, GA; Dhavala, P; Sreenivasan, S; Venkatesan, SG; Zhu, L; Pagano, G; Atiyah, Z; Gregory, J; Morey, T; Seymour, Z; Holdsworth, L; Abdelmahmoud, S; Bourhill, J; Bisheet, G; Shaw, J; Kulkarni, K; Milone, M; Kumarakulasingam, P; Pillay, S; Al-Habsi, R; Kungwengwe, G; Richards, J; Davoudi, K; Ibrahim, B; Tailor, B; Zayed, M; Chen, F; Turri, G; Bailey, S; Sheefat, S; Nawaz, G; Pawar, R; Marsh, S; Sam, ZH; Bentley, RS; Simpson, C; Hughes, J; Lim, Y; Colombo, F; Ooi, R; Toh, WH; Mannion, P; Lovett, A; Hussein, S; Kirby, E; Beckett, RG; Salmon, J; Glynn, T; Choo, SY; Chapman, SJ; Cucinotta, E; Lyons, S; Browne, D; Ravindran, W; Ahmad, S; Zhu, X; McNulty, J; McCarthy, L; Ng, J; Karmally, Z; McTeir, K; Poillucci, G; Hanna, M; Tan, E; Namdeo, S; Schembri, R; Pusey, E; Perra, T; Tutino, R; Belia, F; Coletta, D; Belli, A; Rega, D; Cianci, P; Pirozzolo, G; Espin-Basany, E; Di Lena, M; Perrone, F; Giani, A; Lovisetto, F; Grassia, M; Federico, PNS; Ferrara, F; Biancafarina, A; Tamini, N; Sinibaldi, G; Glasbey, JC; Tuminello, F; Galleano, R; Sasia, D; Bragaglia, L; Garberini, DMA; Pesce, A; Cassaro, F; Venturelli, P; Canu, GL; Esposito, G; Mihaljevic, A; Campanelli, M; Cardia, R; Ricciardiello, M; Sagnotta, A; Canonico, G; De Marco, G; Cappiello, A; Pinotti, E; Carlei, F; Lisi, G; Nepogodiev, D; Bagaglini, G; Farrugia, M; van Praag, MEM; Monteiro, C; Pereira, M; Botelho, P; Quigley, A; O'Neill, A; Gaule, L; Crone, L; Pata, F; Arnold, A; Grama, F; Beuca, A; Tulina, I; Litvin, A; Panyko, A; Ossola, ME; Diaz, TJ; Santos, MJM; Batanero, AE; Pellino, G; de Las Casas, GS; Verdeguer, SC; Colas-Ruiz, E; El-Abur, T; Dominguez, GM; Delorme, M; Sauvain, M; Ozmen, BB; Ozkan, BB; Calikoglu, F; Pockney, P; Kural, S; Zafer, F; Kaya, Y; Yalcinkaya, A; Kargici, K; Tepe, MD; Tatar, OC; Kabadayi, E; Hurmuzlu, D; Korkmaz, K; Ahmed, WUR; Dudi-Venkata, NN; Sharma, P; Troller, R; Hagan, N; Mooney, J; Light, A; Tansey, M; Bhojwani, D; McGing, RM; Mallon, A; Fadel, M; Egoroff, N; Spilsbury, C; James, R; O'Brien, S; Isaac, A; Balasubramanya, S; Sadik, H; Gala, T; Chen, JY; Turner, B; Goh, E; Ludbrook, I.; Hassan, K; Karam, M; Mason, P; Tzoumas, N; Noton, T; Seehra, JK; Ahmed, N; Motiwale, R; Tanna, V; Argyriou, A; Raubenheimer, K; Bylapudi, SK; Grace, N; Latif, S; Hounat, A; Kiam, JS; Zaidi, M; Elsamani, K; Hughes, C; Suresh, A; Sinan, LOH; Richards, T; El-Dalil, D; Khoo, EJM; Salim, EE; Stark, D; Minhas, N; Fowler, G; Rees, E; Giudiceandrea, I; Bardon, A; Jayawardena, P; Delibegovic, S; Dieseru, N; Murphy, A; Yates, C; Ziolkowska, K; Rafie, A; Khoda, F; Okocha, M; Ashdown, T; Vitish-Sharma, P; Gilliland, J; Salibasic, M; Toh, S; Jones, K; Devine, A; Berry, A; McDonnell, S; Olivier, J; Richardson, G; Lim, HJ; Slim, N; Elsayeh, K; Amjad, T; Sammour, T; Sarpanov, A; Belev, N; Dimitrov, D; Dusek, T; Ntomi, V; Sotiropoulos, GC; Theodorou, D; Nikiteas, N; Balalis, D; Dorr-Harim, C; Antropoli, C; Altomare, DF; Luglio, G; De Palma, GD; Pedrazzani, C; Simonelli, L; Brozzetti, S; Porcu, A; Massani, M; Grazi, GL; Gedeon, N; Izzo, F; Delrio, P; Restini, E; Chetta, G; Lantone, G; Ferrari, G; Lucchi, A; De Prizio, M; Caristo, G; Borghi, F; Brindl, N; Gsenger, J; Petrucciani, N; Huscher, C; Cocorullo, G; Tonini, V; Medas, F; Sica, G; Cillara, N; Anastasi, A; Bianco, F; Giuliani, A; Tachezy, M; Carlini, M; Selvaggi, F; Sammarco, G; Malasonoks, A; Andrejevic, P; Tanis, P; van de Ven, A; Gerhards, M; da Silva, RB; Silva, A; Bini, S; Lima, MJ; Kavanagh, D; McCawley, N; Bintintan, V; Karamarkovic, A; Ortega, SG; De Andres-Asenjo, B; Garcia, NC; Florez, GLJ; Segura-Sampedro, JJ; Gallo, G; Laina, BJL; Ponchietti, L; Buchwald, P; Gialamas, E; Ozben, V; Rencuzogullari, A; Altinel, Y; Isik, O; Yoldas, T; Isik, A; Gori, A; Erturk, MS; Guner, A; Guler, SA; Attaallah, W; Marzook, H; Eardley, N; Smolarek, S; Morgan, R; Roxburgh, C; Lala, AK; Picciariello, A; Salama, Y; Singh, B; Khanna, A; Evans, M; Shaikh, I

Intraperitoneal drain placement and outcomes after elective colorectal surgery: International matched, prospective, cohort study

journal contribution

posted on 2025-05-12, 13:03 authored by A Sgro, R Blanco-Colino, W Xu, H Mughal, A Valnarov-Boulter, J Kayran, M Banerjee, N Parekh-Hill, A Hooper, J Bowen, R Jagdish, C Mcquoid, N Khan, OR Hare, M Slavchev, S Jeffery, A Zahid, C Elsworth, L Walter, S Dhillon, S Rao, A Anthony, A Ashaye, N Phillips, R Faderani, T Ivanov, S Pengelly, S Choi, SY Kwak, YHL Lau, K Bagheri, DYC Ong, E Kerr, K Falconer, N Clancy, S Douglas, N Gouvas, Y Zhang, F Greenfield, I Mutanga, J McAlinden, L Willis, A Adefolaju, H Agarwal, R Barter, G Harris, G Spencer, A Hegazi, MW Lee, VT Vadiveloo, G Herbert, R Patel, M Shah, S El Falaha, C Wong, C Soare, J Akram, L Bozhkova, P Kocian, Y Ma, UG Vo, HWN Tan, L Leto, MA Kamal, E Hadzhieva, P Krastev, P Tonchev, G Kokkinos, I Pozotou, MD Kjaer, D Sabbagh, J Votava, F St, N Koliakos, P Tsaparas, G Zografos, D Mantas, G Tsourouflis, E Fradelos, G Trigiante, A Mark-Christensen, G Labellarte, G Resta, G Capelli, V Verlingieri, T Campagnaro, A Maffioli, F Viscosi, C De Lucia, S Meneghini, A Fancellu, D Papakonstantinou, M Colella, A Biondi, V De Peppo, U Pace, V Albino, D Gattulli, A Piangerelli, D Kalivaci, G Sisto, M Mazzola, N Machairas, A Caneparo, EG Lunghi, LC Nespoli, M Angrisani, A Langone, E Gelarda, E Virgilio, E Angelini, C Fornasier, S Asero, KA McLean, T Triantafyllou, E Filippone, F Frongia, PG Calo, P Panaccio, P Ipponi, S Gili, B Braccio, V Tiesi, K Stolcers, L Kokaine, Z Garoufalia, V Novikovs, L Capel, V Bastiaenen, H Heijmans, S Henriques, SZ Gan, H Ramanayake, M Nolan, H Temperley, E Ciofic, D Korkolis, BA Pop, M Kurtenkov, M Vician, EP Arias, BJ de Heredia, LM Martinez, DS Alvarez, M Alvarez-Gallego, RJM Artigas, O Dwidar, A Castaldi, HK Korkmaz, IC Eray, S Meric, R Aydin, B Cetin, BE Karaca, OF Kuyumcu, E Yuksel, TK Uprak, K Karabulut, S Giaccari, E Kavukcu, A Mansor, R Hackett, M Zammit-Maempel, R Sabaratnam, A Maan, I Ferarrio, L Dixon, H Halai, S Sethi, G Spolverato, L Nelson, A Grassam-rowe, E Krishnan, D Deeny, M McKeever, GA Pandeth, P Dhavala, S Sreenivasan, SG Venkatesan, L Zhu, G Pagano, Z Atiyah, J Gregory, T Morey, Z Seymour, L Holdsworth, S Abdelmahmoud, J Bourhill, G Bisheet, J Shaw, K Kulkarni, M Milone, P Kumarakulasingam, S Pillay, R Al-Habsi, G Kungwengwe, J Richards, K Davoudi, B Ibrahim, B Tailor, M Zayed, F Chen, G Turri, S Bailey, S Sheefat, G Nawaz, R Pawar, S Marsh, ZH Sam, RS Bentley, C Simpson, J Hughes, Y Lim, F Colombo, R Ooi, WH Toh, P Mannion, A Lovett, S Hussein, E Kirby, RG Beckett, J Salmon, T Glynn, SY Choo, SJ Chapman, E Cucinotta, S Lyons, D Browne, W Ravindran, S Ahmad, X Zhu, J McNulty, L McCarthy, J Ng, Z Karmally, K McTeir, G Poillucci, M Hanna, E Tan, S Namdeo, R Schembri, E Pusey, T Perra, R Tutino, F Belia, D Coletta, A Belli, D Rega, P Cianci, G Pirozzolo, E Espin-Basany, M Di Lena, F Perrone, A Giani, F Lovisetto, M Grassia, PNS Federico, F Ferrara, A Biancafarina, N Tamini, G Sinibaldi, JC Glasbey, F Tuminello, R Galleano, D Sasia, L Bragaglia, DMA Garberini, A Pesce, F Cassaro, P Venturelli, GL Canu, G Esposito, A Mihaljevic, M Campanelli, R Cardia, M Ricciardiello, A Sagnotta, G Canonico, G De Marco, A Cappiello, E Pinotti, F Carlei, G Lisi, D Nepogodiev, G Bagaglini, M Farrugia, MEM van Praag, C Monteiro, M Pereira, P Botelho, A Quigley, A O'Neill, L Gaule, L Crone, F Pata, A Arnold, F Grama, A Beuca, I Tulina, A Litvin, A Panyko, ME Ossola, TJ Diaz, MJM Santos, AE Batanero, G Pellino, GS de Las Casas, SC Verdeguer, E Colas-Ruiz, T El-Abur, GM Dominguez, M Delorme, M Sauvain, BB Ozmen, BB Ozkan, F Calikoglu, P Pockney, S Kural, F Zafer, Y Kaya, A Yalcinkaya, K Kargici, MD Tepe, OC Tatar, E Kabadayi, D Hurmuzlu, K Korkmaz, WUR Ahmed, NN Dudi-Venkata, P Sharma, R Troller, N Hagan, J Mooney, A Light, M Tansey, D Bhojwani, RM McGing, A Mallon, M Fadel, N Egoroff, C Spilsbury, R James, S O'Brien, A Isaac, S Balasubramanya, H Sadik, T Gala, JY Chen, B Turner, E Goh, I. Ludbrook, K Hassan, M Karam, P Mason, N Tzoumas, T Noton, JK Seehra, N Ahmed, R Motiwale, V Tanna, A Argyriou, K Raubenheimer, SK Bylapudi, N Grace, S Latif, A Hounat, JS Kiam, M Zaidi, K Elsamani, C Hughes, A Suresh, LOH Sinan, T Richards, D El-Dalil, EJM Khoo, EE Salim, D Stark, N Minhas, G Fowler, E Rees, I Giudiceandrea, A Bardon, P Jayawardena, S Delibegovic, N Dieseru, A Murphy, C Yates, K Ziolkowska, A Rafie, F Khoda, M Okocha, T Ashdown, P Vitish-Sharma, J Gilliland, M Salibasic, S Toh, K Jones, A Devine, A Berry, S McDonnell, J Olivier, G Richardson, HJ Lim, N Slim, K Elsayeh, T Amjad, T Sammour, A Sarpanov, N Belev, D Dimitrov, T Dusek, V Ntomi, GC Sotiropoulos, D Theodorou, N Nikiteas, D Balalis, C Dorr-Harim, C Antropoli, DF Altomare, G Luglio, GD De Palma, C Pedrazzani, L Simonelli, S Brozzetti, A Porcu, M Massani, GL Grazi, N Gedeon, F Izzo, P Delrio, E Restini, G Chetta, G Lantone, G Ferrari, A Lucchi, M De Prizio, G Caristo, F Borghi, N Brindl, J Gsenger, N Petrucciani, C Huscher, G Cocorullo, V Tonini, F Medas, G Sica, N Cillara, A Anastasi, F Bianco, A Giuliani, M Tachezy, M Carlini, F Selvaggi, G Sammarco, A Malasonoks, P Andrejevic, P Tanis, A van de Ven, M Gerhards, RB da Silva, A Silva, S Bini, MJ Lima, D Kavanagh, N McCawley, V Bintintan, A Karamarkovic, SG Ortega, B De Andres-Asenjo, NC Garcia, GLJ Florez, JJ Segura-Sampedro, G Gallo, BJL Laina, L Ponchietti, P Buchwald, E Gialamas, V Ozben, A Rencuzogullari, Y Altinel, O Isik, T Yoldas, A Isik, A Gori, MS Erturk, A Guner, SA Guler, W Attaallah, H Marzook, N Eardley, S Smolarek, R Morgan, C Roxburgh, AK Lala, A Picciariello, Y Salama, B Singh, A Khanna, M Evans, I Shaikh

Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien–Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk.

History

Journal title

BritishJournal of Surgery

Volume

109

Issue

6

Pagination

520-529

Publisher

Oxford University Press

Language

en, English

College/Research Centre

College of Health, Medicine and Wellbeing

School

School of Medicine and Public Health

Rights statement

© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited