Prophylactic abdominal drainage for pancreatic surgery
Information
- DOI:
- https://doi.org/10.1002/14651858.CD010583.pub5Copy DOI
- Database:
-
- Cochrane Database of Systematic Reviews
- Version published:
-
- 18 December 2021see what's new
- Type:
-
- Intervention
- Stage:
-
- Review
- Cochrane Editorial Group:
-
Cochrane Gut Group
- Copyright:
-
- Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Article metrics
Altmetric:
Cited by:
Authors
Contributions of authors
Conceiving the review: YC
Designing the review: SH
Co‐ordinating the review: JX
Designing search strategies: SH, WZ
Study selection: SH, WZ
Data extraction: ML, ZL
Writing the review: SH, JX
Providing general advice on the review: NC
Securing funding for the review: ZL
Performing previous work that was the foundation of the current study: YC
Sources of support
Internal sources
-
Chongqing Medical University, China
This review was supported by National Natural Science Foundation of China (Grant No. 81701950, 82172135), Medical Research Projects of Chongqing (Grant No. 2018MSXM132), and the Kuanren Talents Program of the second affiliated hospital of Chongqing Medical University (Grant No. KY2019Y002).
External sources
-
No sources of support provided
Declarations of interest
SH: None known
JX: None known
WZ: None known
ML: None known
NC: None known
ZL: None known
YC: None known
Acknowledgements
We acknowledge the contribution of authors of previous version of this review: Wei Zhang, Sirong He, Yao Cheng, Jie Xia, Mingliang Lai, Nansheng Cheng, Zuojin Liu.
We acknowledge the help and support of the Cochrane Gut Group. The authors would also like to thank the following editors and peer referees who provided comments on the present review update: Claudio Bassi (Peer Reviewer), Huan Song (Editor), Yuhong Yuan (Information Specialist and previous Managing Editor), Teo Quay (Managing Editor), Frances Tse (Contact Editor), Grigorios Leontiadis (Sign‐Off Editor). We would also like to thank Victoria Pennick for copy‐editing this version of the review.
Yuhong Yuan (Information Specialist, Cochrane Gut Group) revised the search strategies in this updated version.
The Methods section of this review is based on a standard template provided by Cochrane Gut Group.
Version history
| Published | Title | Stage | Authors | Version |
| 2021 Dec 18 | Prophylactic abdominal drainage for pancreatic surgery | Review | Sirong He, Jie Xia, Wei Zhang, Mingliang Lai, Nansheng Cheng, Zuojin Liu, Yao Cheng | |
| 2018 Jun 21 | Prophylactic abdominal drainage for pancreatic surgery | Review | Wei Zhang, Sirong He, Yao Cheng, Jie Xia, Mingliang Lai, Nansheng Cheng, Zuojin Liu | |
| 2016 Oct 21 | Prophylactic abdominal drainage for pancreatic surgery | Review | Yao Cheng, Jie Xia, Mingliang Lai, Nansheng Cheng, Sirong He | |
| 2015 Aug 21 | Prophylactic abdominal drainage for pancreatic surgery | Review | Su Peng, Yao Cheng, Chen Yang, Jiong Lu, Sijia Wu, Rongxing Zhou, Nansheng Cheng | |
| 2013 Jun 12 | Prophylactic abdominal drainage for pancreatic surgery | Protocol | Yao Cheng, Chen Yang, Yixin Lin, Jiong Lu, Sijia Wu, Rongxing Zhou, Nansheng Cheng | |
Differences between protocol and review
-
We updated the search strategies with the help of the Cochrane Gut Group Information Specialist.
-
We added time points of measurement for all outcomes.
-
Because overall infectious complications were not reported, we chose two types of infectious complication (intra‐abdominal infection and wound infection) for the summary of findings table.
-
We did not perform any subgroup analyses because of an insufficient number of studies were included in the meta‐analyses.
-
We did not create funnel plots to assess reporting biases because there were fewer than 10 included studies.
-
We did not perform the planned sensitivity analysis by calculating SMD for continuous data with same measurement scales in different RCTs or calculating MD for continuous data with different measurement scales in different RCTs, because none of the continuous outcomes were assessed in the sensitivity analyses. We performed the other planned sensitivity analyses for primary outcomes, including 30‐day mortality, 90‐day mortality, intra‐abdominal infection, wound infection, and drain‐related complications.
Notes
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Humans;
PICOs
Study flow diagram: 2021 review update
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Comparison 1: Drain use versus no drain use, Outcome 1: Mortality (30 days)
Comparison 1: Drain use versus no drain use, Outcome 2: Mortality (90 days)
Comparison 1: Drain use versus no drain use, Outcome 3: Intra‐abdominal infection
Comparison 1: Drain use versus no drain use, Outcome 4: Wound infection
Comparison 1: Drain use versus no drain use, Outcome 5: Morbidity
Comparison 1: Drain use versus no drain use, Outcome 6: Length of hospital stay (days)
| Length of hospital stay | ||||
| Study | Number in study | Comparison | Results | Comment |
|---|---|---|---|---|
| Conlon 2001 | 179 (91 versus 88) | Drain use versus no drain use | Drain use versus no drain use: median (range): 9 (3‐34) versus 9 (5‐44), without reporting the p value | Authors reported that there was no difference in the length of hospital stay between groups |
Comparison 1: Drain use versus no drain use, Outcome 7: Length of hospital stay
Comparison 1: Drain use versus no drain use, Outcome 8: Additional open procedures for postoperative complications
Comparison 1: Drain use versus no drain use, Outcome 9: Additional radiological interventions for postoperative complications
Comparison 2: Active drain versus passive drain, Outcome 1: Mortality (30 days)
Comparison 2: Active drain versus passive drain, Outcome 2: Intra‐abdominal infection
Comparison 2: Active drain versus passive drain, Outcome 3: Wound infection
Comparison 2: Active drain versus passive drain, Outcome 4: Morbidity
Comparison 2: Active drain versus passive drain, Outcome 5: Length of hospital stay (days)
Comparison 2: Active drain versus passive drain, Outcome 6: Additional open procedures for postoperative complications
Comparison 3: Early versus late drain removal, Outcome 1: Mortality (30 days)
Comparison 3: Early versus late drain removal, Outcome 2: Intra‐abdominal infection
Comparison 3: Early versus late drain removal, Outcome 3: Wound infection
Comparison 3: Early versus late drain removal, Outcome 4: Morbidity
Comparison 3: Early versus late drain removal, Outcome 5: Length of hospital stay (days)
Comparison 3: Early versus late drain removal, Outcome 6: Hospital costs
Comparison 3: Early versus late drain removal, Outcome 7: Additional open procedures for postoperative complications
Comparison 3: Early versus late drain removal, Outcome 8: Additional radiological interventions for postoperative complications
| Drain use versus no drain use following pancreatic surgery | ||||||
|---|---|---|---|---|---|---|
| Patient or population: people undergoing elective pancreatic resections | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
| Risk with no drain use | Risk with drain use | |||||
| Mortality Follow‐up: 30 days | 23 per 1000 | 18 per 1000 (7 to 46) | RR 0.78 | 1055 | ⊕⊕⊝⊝ | Low‐certainty evidence suggested that drain use may result in little to no difference in 30‐day mortality compared with no drain use. |
| Mortality Follow‐up: 90 days | 42 per 1000 | 10 per 1000 (3 to 38) | RR 0.23 | 478 | ⊕⊕⊝⊝ | Low‐certainty evidence suggested that drain use may result in a slight reduction in 90‐day mortality compared with no drain use. |
| Intra‐abdominal infection Follow‐up: 30 days | 82 per 1000 | 80 per 1000 (43 to 148) | RR 0.97 | 1055 | ⊕⊝⊝⊝ | The evidence was very uncertain about the effect of drain use on intra‐abdominal infection rate compared with no drain use. |
| Wound infection Follow‐up: 30 days | 99 per 1000 | 97 per 1000 (68 to 140) | RR 0.98 | 1055 | ⊕⊕⊝⊝ | Low‐certainty evidence suggested that drain use may result in little to no difference in wound infection rate compared with no drain use. |
| Drain‐related complications Follow‐up: 30 days | See comment | See comment | Not estimable | 179 | ⊕⊕⊝⊝ | Low‐certainty evidence suggested that drain use may result in little to no difference in drain‐related complications compared with no drain use. There was 1 drain‐related complication in the drainage group. The drainage tube was broken. |
| Morbidity Follow‐up: 30 days | 597 per 1000 | 614 per 1000 (561 to 674) | RR 1.03 | 1055 | ⊕⊕⊕⊝ | Moderate‐certainty evidence suggested that drain use probably resulted in little to no difference in morbidity compared with no drain use. |
| Length of hospital stay Follow‐up: 30 days | The mean length of hospital stay in the no drain groups was 11.3 days | The mean length of hospital stay in the drain groups was | MD ‐0.14 (‐0.79 to 0.51) | 876 | ⊕⊕⊝⊝ | One study including 179 participants reported the median and range values which were not suitable for pooling. This study reported no difference in the length of hospital stay between groups. Low‐certainty evidence suggested that drain use may result in little to no difference in length of hospital stay compared with no drain use. |
| * The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the control group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MD: mean difference; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level for serious risk of bias: three studies with high risk of incomplete outcome data | ||||||
| Active drain versus passive drain following pancreatic surgery | ||||||
|---|---|---|---|---|---|---|
| Patient or population: people undergoing elective pancreatic resections | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
| Risk with passive drain | Risk with Active drain | |||||
| Mortality Follow‐up: 30 days | 16 per 1000 | 20 per 1000 | RR 1.23 | 382 | ⊕⊝⊝⊝ | The evidence was very uncertain about the effect of an active drain on 30‐day mortality compared with passive drain. |
| Mortality Follow‐up: 90 days | Not reported | |||||
| Intra‐abdominal infection Follow‐up: 30 days | 101 per 1000 | 88 per 1000 | RR 0.87 | 321 | ⊕⊝⊝⊝ | The evidence was very uncertain about the effect of an active drain on intra‐abdominal infection rate compared with passive drain. |
| Wound infection Follow‐up: 30 days | 88 per 1000 | 81 per 1000 | RR 0.92 | 321 | ⊕⊝⊝⊝ | The evidence was very uncertain about the effect of an active drain on wound infection rate compared with passive drain. |
| Drain‐related complications Follow‐up: 30 days | See comment | See comment | Not estimable | 223 (1 study) | ⊕⊝⊝⊝ | There were no drain‐related complications in either group. |
| Morbidity Follow‐up: 30 days | 370 per 1000 | 359 per 1000 | RR 0.97 | 382 | ⊕⊝⊝⊝ | The evidence was very uncertain about the effect of an active drain on morbidity compared with passive drain. |
| Length of hospital stay Follow‐up: 30 days | The mean length of hospital stay in the passive drain group was 14.5 days | The mean length of hospital stay in the active drain group was | MD ‐0.79 | 321 | ⊕⊝⊝⊝ | The evidence was very uncertain about the effect of an active drain on length of hospital stay compared with passive drain. |
| * The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the control group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level for serious risk of bias: one study with unclear risk of incomplete outcome data | ||||||
| Early versus late drain removal following pancreatic surgery | ||||||
|---|---|---|---|---|---|---|
| Patient or population: people undergoing elective pancreatic resections | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
| Risk with late drain removal | Risk with early drain removal | |||||
| Mortality Follow‐up: 30 days | 5 per 1000 | 5 per 1000 | RR 0.99 | 399 | ⊕⊝⊝⊝ | The evidence was very uncertain about the effect of early drain removal on 30‐day mortality compared with late drain removal. |
| Mortality Follow‐up: 90 days | Not reported | |||||
| Intra‐abdominal infection Follow‐up: 30 days | 162 per 1000 | 71 per 1000 | RR 0.44 | 285 | ⊕⊝⊝⊝ | The evidence suggested that early drain removal may reduce intra‐abdominal infection rate compared with late drain removal but the evidence was very uncertain. |
| Wound infection Follow‐up: 30 days | 35 per 1000 | 46 per 1000 | RR 1.32 | 285 | ⊕⊝⊝⊝ | The evidence was very uncertain about the effect of early drain removal on wound infection rate compared with late drain removal. |
| Drain‐related complications Follow‐up: 30 days | Not reported | |||||
| Morbidity Follow‐up: 30 days | 659 per 1000 | 323 per 1000 | RR 0.49 | 258 | ⊕⊝⊝⊝ | The evidence suggested that early drain removal may reduce morbidity compared with late drain removal but the evidence was very uncertain. |
| Length of hospital stay Follow‐up: 30 days | The mean length of hospital stay in the late drain removal group was 15.4 days | The mean length of hospital stay in the early drain removal group was 2.2 days lower | MD ‐2.2 | 399 | ⊕⊝⊝⊝ | The evidence suggested that early drain removal may reduce length of hospital stay compared with late drain removal but the evidence was very uncertain. |
| * The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the control group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| aNot downgraded for risk of bias because this is considered an objective outcome that is unlikely to be affected by performance bias or detection bias | ||||||
| Comparisons | Outcomes | Main analysis (random‐effects model) | Fixed‐effect model | RD for dichotomous outcomes | OR for dichotomous outcomes | worst‐case scenario and best‐case scenario analysis for missing data | |
|---|---|---|---|---|---|---|---|
| worst/best‐case | best/worst‐case | ||||||
| Drain use versus no drain use | Mortality (30 days) | RR 0.78 (0.31 to 1.99) | RR 0.67 (0.28 to 1.58) | RD ‐0.01 (‐0.03 to 0.01) | OR 0.77 (0.29 to 2.03) | RR 2.58 (0.41 to 16.09) | RR 0.17 (0.04 to 0.79) |
| Drain use versus no drain use | Mortality (90 days) | RR 0.23 (0.06 to 0.90) | RR 0.23 (0.06 to 0.90) | RD ‐0.05 (‐0.16 to 0.07) | OR 0.21 (0.05 to 0.87) | RR 2.27 (0.06 to 84.61) | RR 0.07 (0.00 to 1.23) |
| Drain use versus no drain use | Intra‐abdominal infection | RR 0.97 (0.52 to 1.80) | RR 0.97 (0.64 to 1.45) | RD ‐0.00 (‐0.06 to 0.05) | OR 0.96 (0.48 to 1.92) | RR 1.72 (0.59 to 4.96) | RR 0.45 (0.31 to 0.63) |
| Drain use versus no drain use | Wound infection | RR 0.98 (0.68 to 1.41) | RR 0.98 (0.68 to 1.41) | RD 0.01 (‐0.03 to 0.04) | OR 0.98 (0.65 to 1.48) | RR 1.79 (0.81 to 3.95) | RR 0.53 (0.29 to 0.95) |
| Drain use versus no drain use | Drain‐related complications | ‐ | ‐ | ‐ | ‐ | ‐ | ‐ |
| Active drain versus passive drain | Mortality (30 days) | RR 1.23 (0.30 to 5.06) | RR 1.27 (0.32 to 5.07) | RD 0.01 (‐0.02 to 0.03) | OR 1.24 (0.29 to 5.28) | RR 1.51 (0.40 to 5.77) | RR 1.22 (0.30 to 5.02) |
| Active drain versus passive drain | Mortality (90 days) | ‐ | ‐ | ‐ | ‐ | ‐ | ‐ |
| Active drain versus passive drain | Intra‐abdominal infection | RR 0.87 (0.21 to 3.66) | RR 1.07 (0.58 to 1.96) | RD ‐0.00 (‐0.10 to 0.10) | OR 0.87 (0.19 to 4.07) | RR 0.88 (0.20 to 3.99) | RR 0.87 (0.21 to 3.57) |
| Active drain versus passive drain | Wound infection | RR 0.92 (0.44 to 1.90) | RR 0.91 (0.44 to 1.88) | RD ‐0.01 (‐0.07 to 0.05) | OR 0.91 (0.41 to 2.01) | RR 0.98 (0.48 to 2.01) | RR 0.91 (0.44 to 1.89) |
| Active drain versus passive drain | Drain‐related complications | ‐ | ‐ | ‐ | ‐ | ‐ | ‐ |
| Early versus late drain removal | Mortality (30 days) | RR 0.99 (0.06 to 15.45) | RR 0.99 (0.06 to 15.45) | RD ‐0.00 (‐0.02 to 0.02) | OR 0.99 (0.06 to 16.08) | RR 0.99 (0.06 to 15.45) | RR 0.99 (0.06 to15.45) |
| Early versus late drain removal | Mortality (90 days) | ‐ | ‐ | ‐ | ‐ | ‐ | ‐ |
| Early versus late drain removal | Intra‐abdominal infection | RR 0.44 (0.22 to 0.89) | RR 0.43 (0.21 to 0.87) | RD ‐0.09 (‐0.17 to ‐0.02) | OR 0.39 (0.18 to 0.87) | RR 0.44 (0.22 to 0.89) | RR 0.44 (0.22 to 0.89) |
| Early versus late drain removal | Wound infection | RR 1.32 (0.45 to 3.85) | RR 1.35 (0.47 to 3.90) | RD 0.01 (‐0.02 to 0.05) | OR 1.35 (0.43 to 4.29) | RR 1.32 (0.45 to 3.85) | RR 1.32 (0.45 to 3.85) |
| Early versus late drain removal | Drain‐related complications | ‐ | ‐ | ‐ | ‐ | ‐ | ‐ |
| ‐: not available; OR: odds ratios; RR: risk ratio; RD: risk differences | |||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Mortality (30 days) Show forest plot | 4 | 1055 | Risk Ratio (M‐H, Random, 95% CI) | 0.78 [0.31, 1.99] |
| 1.2 Mortality (90 days) Show forest plot | 2 | 478 | Risk Ratio (M‐H, Random, 95% CI) | 0.23 [0.06, 0.90] |
| 1.3 Intra‐abdominal infection Show forest plot | 4 | 1055 | Risk Ratio (M‐H, Random, 95% CI) | 0.97 [0.52, 1.80] |
| 1.4 Wound infection Show forest plot | 4 | 1055 | Risk Ratio (M‐H, Random, 95% CI) | 0.98 [0.68, 1.41] |
| 1.5 Morbidity Show forest plot | 4 | 1055 | Risk Ratio (M‐H, Random, 95% CI) | 1.03 [0.94, 1.13] |
| 1.6 Length of hospital stay (days) Show forest plot | 3 | 876 | Mean Difference (IV, Random, 95% CI) | ‐0.14 [‐0.79, 0.51] |
| 1.7 Length of hospital stay Show forest plot | 1 | Other data | No numeric data | |
| 1.8 Additional open procedures for postoperative complications Show forest plot | 4 | 1055 | Risk Ratio (M‐H, Random, 95% CI) | 1.33 [0.79, 2.23] |
| 1.9 Additional radiological interventions for postoperative complications Show forest plot | 3 | 660 | Risk Ratio (M‐H, Random, 95% CI) | 0.87 [0.40, 1.87] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Mortality (30 days) Show forest plot | 2 | 382 | Risk Ratio (M‐H, Random, 95% CI) | 1.23 [0.30, 5.06] |
| 2.2 Intra‐abdominal infection Show forest plot | 2 | 321 | Risk Ratio (M‐H, Random, 95% CI) | 0.87 [0.21, 3.66] |
| 2.3 Wound infection Show forest plot | 2 | 321 | Risk Ratio (M‐H, Random, 95% CI) | 0.92 [0.44, 1.90] |
| 2.4 Morbidity Show forest plot | 2 | 382 | Risk Ratio (M‐H, Random, 95% CI) | 0.97 [0.53, 1.77] |
| 2.5 Length of hospital stay (days) Show forest plot | 2 | 321 | Mean Difference (IV, Random, 95% CI) | ‐0.79 [‐2.63, 1.04] |
| 2.6 Additional open procedures for postoperative complications Show forest plot | 2 | 321 | Risk Ratio (M‐H, Random, 95% CI) | 0.44 [0.11, 1.83] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Mortality (30 days) Show forest plot | 3 | 399 | Risk Ratio (M‐H, Random, 95% CI) | 0.99 [0.06, 15.45] |
| 3.2 Intra‐abdominal infection Show forest plot | 2 | 285 | Risk Ratio (M‐H, Random, 95% CI) | 0.44 [0.22, 0.89] |
| 3.3 Wound infection Show forest plot | 2 | 285 | Risk Ratio (M‐H, Random, 95% CI) | 1.32 [0.45, 3.85] |
| 3.4 Morbidity Show forest plot | 2 | 258 | Risk Ratio (M‐H, Random, 95% CI) | 0.49 [0.30, 0.81] |
| 3.5 Length of hospital stay (days) Show forest plot | 3 | 399 | Mean Difference (IV, Random, 95% CI) | ‐2.20 [‐3.52, ‐0.87] |
| 3.6 Hospital costs Show forest plot | 2 | 258 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.22 [‐0.59, 0.14] |
| 3.7 Additional open procedures for postoperative complications Show forest plot | 3 | 399 | Risk Ratio (M‐H, Random, 95% CI) | 0.77 [0.28, 2.10] |
| 3.8 Additional radiological interventions for postoperative complications Show forest plot | 1 | 144 | Risk Ratio (M‐H, Random, 95% CI) | 1.00 [0.21, 4.79] |
