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Cochrane Database of Systematic Reviews

Saliran abdomen profilaksis untuk pembedahan pankreas

Información

DOI:
https://doi.org/10.1002/14651858.CD010583.pub5Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 18 diciembre 2021see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Salud digestiva

Copyright:
  1. Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Sirong He

    Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China

  • Jie Xia

    The Key Laboratory of Molecular Biology on Infectious Diseases, Chongqing Medical University, Chongqing, China

  • Wei Zhang

    Department of Hepatopancreatobiliary Surgery, The People's Hospital of Jianyang City, Jianyang, China

  • Mingliang Lai

    Department of Clinical Laboratory, Jiangjin Central Hospital, Chongqing, China

  • Nansheng Cheng

    Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, China

  • Zuojin Liu

    Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China

  • Yao Cheng

    Correspondencia a: Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China

    [email protected]

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

https://doi.org/10.1002/14651858.CD010583.pub5

2018 Jun 21

Prophylactic abdominal drainage for pancreatic surgery

Review

Wei Zhang, Sirong He, Yao Cheng, Jie Xia, Mingliang Lai, Nansheng Cheng, Zuojin Liu

https://doi.org/10.1002/14651858.CD010583.pub4

2016 Oct 21

Prophylactic abdominal drainage for pancreatic surgery

Review

Yao Cheng, Jie Xia, Mingliang Lai, Nansheng Cheng, Sirong He

https://doi.org/10.1002/14651858.CD010583.pub3

2015 Aug 21

Prophylactic abdominal drainage for pancreatic surgery

Review

Su Peng, Yao Cheng, Chen Yang, Jiong Lu, Sijia Wu, Rongxing Zhou, Nansheng Cheng

https://doi.org/10.1002/14651858.CD010583.pub2

2013 Jun 12

Prophylactic abdominal drainage for pancreatic surgery

Protocol

Yao Cheng, Chen Yang, Yixin Lin, Jiong Lu, Sijia Wu, Rongxing Zhou, Nansheng Cheng

https://doi.org/10.1002/14651858.CD010583

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 Check Words

Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram: 2021 review update

Figuras y tablas -
Figure 1

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

Figuras y tablas -
Figure 2

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

Figuras y tablas -
Figure 3

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)

Figuras y tablas -
Analysis 1.1

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)

Figuras y tablas -
Analysis 1.2

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

Figuras y tablas -
Analysis 1.3

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

Figuras y tablas -
Analysis 1.4

Comparison 1: Drain use versus no drain use, Outcome 4: Wound infection

Comparison 1: Drain use versus no drain use, Outcome 5: Morbidity

Figuras y tablas -
Analysis 1.5

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)

Figuras y tablas -
Analysis 1.6

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

Figuras y tablas -
Analysis 1.7

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

Figuras y tablas -
Analysis 1.8

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

Figuras y tablas -
Analysis 1.9

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)

Figuras y tablas -
Analysis 2.1

Comparison 2: Active drain versus passive drain, Outcome 1: Mortality (30 days)

Comparison 2: Active drain versus passive drain, Outcome 2: Intra‐abdominal infection

Figuras y tablas -
Analysis 2.2

Comparison 2: Active drain versus passive drain, Outcome 2: Intra‐abdominal infection

Comparison 2: Active drain versus passive drain, Outcome 3: Wound infection

Figuras y tablas -
Analysis 2.3

Comparison 2: Active drain versus passive drain, Outcome 3: Wound infection

Comparison 2: Active drain versus passive drain, Outcome 4: Morbidity

Figuras y tablas -
Analysis 2.4

Comparison 2: Active drain versus passive drain, Outcome 4: Morbidity

Comparison 2: Active drain versus passive drain, Outcome 5: Length of hospital stay (days)

Figuras y tablas -
Analysis 2.5

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

Figuras y tablas -
Analysis 2.6

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)

Figuras y tablas -
Analysis 3.1

Comparison 3: Early versus late drain removal, Outcome 1: Mortality (30 days)

Comparison 3: Early versus late drain removal, Outcome 2: Intra‐abdominal infection

Figuras y tablas -
Analysis 3.2

Comparison 3: Early versus late drain removal, Outcome 2: Intra‐abdominal infection

Comparison 3: Early versus late drain removal, Outcome 3: Wound infection

Figuras y tablas -
Analysis 3.3

Comparison 3: Early versus late drain removal, Outcome 3: Wound infection

Comparison 3: Early versus late drain removal, Outcome 4: Morbidity

Figuras y tablas -
Analysis 3.4

Comparison 3: Early versus late drain removal, Outcome 4: Morbidity

Comparison 3: Early versus late drain removal, Outcome 5: Length of hospital stay (days)

Figuras y tablas -
Analysis 3.5

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

Figuras y tablas -
Analysis 3.6

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

Figuras y tablas -
Analysis 3.7

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

Figuras y tablas -
Analysis 3.8

Comparison 3: Early versus late drain removal, Outcome 8: Additional radiological interventions for postoperative complications

Summary of findings 1. Drain use versus no drain use following pancreatic surgery

Drain use versus no drain use following pancreatic surgery

Patient or population: people undergoing elective pancreatic resections
Setting: hospital
Intervention: drain use
Comparison: no drain use

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Certainty of the evidence
(GRADE)

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
(0.31 to 1.99)

1055
(4 studies)

⊕⊕⊝⊝
Lowa,b

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
(0.06 to 0.90)

478
(2 studies)

⊕⊕⊝⊝
Lowc,d

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
(0.52 to 1.80)

1055
(4 studies)

⊕⊝⊝⊝
Very lowa,b,e

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
(0.68 to 1.41)

1055
(4 studies)

⊕⊕⊝⊝
Lowa,b

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
(1 study)

⊕⊕⊝⊝
Lowf,g

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
(0.94 to 1.13)

1055
(4 studies)

⊕⊕⊕⊝
Moderate a

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
0.14 days lower
(0.79 lower to 0.51 higher)

MD ‐0.14 (‐0.79 to 0.51)

876
(3 studies)

⊕⊕⊝⊝
Lowh

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
High certainty. We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty. We are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty. Our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect
Very low certainty. We have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect

aDowngraded one level for serious risk of bias: three studies with high risk of incomplete outcome data
bDowngraded one level for serious imprecision: few events and a confidence interval that includes both potential benefit and potential harm from the intervention
cDowngraded one level for serious risk of bias: two studies with high risk of incomplete outcome data
dDowngraded one level for serious imprecision: few events
eDowngraded one level for serious unexplained inconsistency: substantial heterogeneity I²= 52%
fNot downgraded for risk of bias because this is considered an objective outcome that is unlikely to be affected by selection bias or performance bias
gDowngraded two levels for very serious imprecision: small sample size and very few events
hDowngraded two levels for very serious risk of bias: three studies with high risk of incomplete outcome data, all studies with high risk of performance bias, and this outcome was primarily determined by the surgeons

Figuras y tablas -
Summary of findings 1. Drain use versus no drain use following pancreatic surgery
Summary of findings 2. Active drain versus passive drain following pancreatic surgery

Active drain versus passive drain following pancreatic surgery

Patient or population: people undergoing elective pancreatic resections
Setting: hospital
Intervention: active drain
Comparison: passive drain

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with passive drain

Risk with Active drain

Mortality

Follow‐up: 30 days

16 per 1000

20 per 1000
(5 to 80)

RR 1.23
(0.30 to 5.06)

382
(2 studies)

⊕⊝⊝⊝
Very lowa,b

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
(21 to 368)

RR 0.87
(0.21 to 3.66)

321
(2 studies)

⊕⊝⊝⊝
Very lowa,b

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
(39 to 167)

RR 0.92
(0.44 to 1.90)

321
(2 studies)

⊕⊝⊝⊝
Very lowa,b

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)

⊕⊝⊝⊝
Very Lowa,b

There were no drain‐related complications in either group.

Morbidity

Follow‐up: 30 days

370 per 1000

359 per 1000
(196 to 656)

RR 0.97
(0.53 to 1.77)

382
(2 studies)

⊕⊝⊝⊝
Very lowa,c,d

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
0.79 days lower
(2.63 days lower to 1.04 days higher)

MD ‐0.79
(‐2.63 to 1.04)

321
(2 studies)

⊕⊝⊝⊝
Very lowc,e,f

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).
CI: confidence interval; MD: mean difference; RR: risk ratio

GRADE Working Group grades of evidence
High certainty. We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty. We are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty. Our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect
Very low certainty. We have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect

aDowngraded one level for serious risk of bias: one study with unclear risk of incomplete outcome data
bDowngraded two levels for very serious imprecision: small sample size, few events, and wide confidence intervals
cDowngraded one level for serious imprecision: small sample size and a confidence interval that includes both potential benefit and potential harm from the intervention
dDowngraded one level for serious unexplained inconsistency: substantial heterogeneity I²= 76%
eDowngraded two levels for very serious risk of bias: one study with high risk of incomplete outcome data, both studies with high risk of performance bias, and this outcome was primarily determined by the surgeons
fDowngraded one level for serious unexplained inconsistency: substantial heterogeneity I²= 72%

Figuras y tablas -
Summary of findings 2. Active drain versus passive drain following pancreatic surgery
Summary of findings 3. Early versus late drain removal following pancreatic surgery

Early versus late drain removal following pancreatic surgery

Patient or population: people undergoing elective pancreatic resections
Setting: hospital
Intervention: early drain removal
Comparison: late drain removal

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with late drain removal

Risk with early drain removal

Mortality

Follow‐up: 30 days

5 per 1000

5 per 1000
(0 to 78)

RR 0.99
(0.06 to 15.45)

399
(3 RCTs)

⊕⊝⊝⊝
Very lowa,b,g

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
(36 to 144)

RR 0.44
(0.22 to 0.89)

285
(2 RCTs)

⊕⊝⊝⊝
Very lowa,c,g

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
(16 to 136)

RR 1.32
(0.45 to 3.85)

285
(2 RCTs)

⊕⊝⊝⊝
Very lowa,b,g

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
(198 to 534)

RR 0.49
(0.30 to 0.81)

258
(2 RCTs)

⊕⊝⊝⊝
Very lowa,d,f,g

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
(3.52 days lower to 0.87 days lower)

MD ‐2.2
(‐3.52 to ‐0.87)

399
(3 RCTs)

⊕⊝⊝⊝
Very lowe,f,g

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).
CI: confidence interval; MD: mean difference; RR: risk ratio

GRADE Working Group grades of evidence
High certainty. We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty. We are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty. Our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect
Very low certainty. We have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect

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
bDowngraded two levels for very serious imprecision: small sample size, few events, and wide confidence intervals
cDowngraded two levels for very serious imprecision: small sample size and few events
dDowngraded one level for serious unexplained inconsistency: substantial heterogeneity I²= 67%
eDowngraded two levels for very serious risk of bias: all studies with high risk of performance bias, and this outcome was primarily determined by the surgeons
fDowngraded one level due to serious imprecision: total population size was less than 400
gDowngraded one level for indirectness: different time points for early drain removal, and different definitions of low risk of postoperative pancreatic fistula

Figuras y tablas -
Summary of findings 3. Early versus late drain removal following pancreatic surgery
Table 1. Sensitivity analyses

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

Figuras y tablas -
Table 1. Sensitivity analyses
Comparison 1. Drain use versus no drain use

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]

Figuras y tablas -
Comparison 1. Drain use versus no drain use
Comparison 2. Active drain versus passive drain

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]

Figuras y tablas -
Comparison 2. Active drain versus passive drain
Comparison 3. Early versus late drain removal

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]

Figuras y tablas -
Comparison 3. Early versus late drain removal