Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Initial suction drainage decreases severe postoperative complications after pancreatic trauma: A cohort study
Kai-Wei Li, Kai Wang, Yue-Peng Hu, Chao Yang, Yun-Xuan Deng, Xin-Yu Wang, Yu-Xiu Liu, Wei-Qin Li, Wei-Wei Ding
Kai-Wei Li, The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Kai-Wei Li, Yue-Peng Hu, Wei-Qin Li, Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, Jiangsu Province, China
Kai Wang, Chao Yang, Yun-Xuan Deng, Xin-Yu Wang, Wei-Wei Ding, Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, Jiangsu Province, China
Yu-Xiu Liu, Division of Data and Statistics, Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, Jiangsu Province, China
Author contributions: Li KW designed and performed the research and drafted the manuscript; Wang K, Yang C, Deng YX and Wang XY were involved in the literature search and data extraction; Li KW and Hu YP analyzed and interpreted the data; Ding WW, Liu YX and Li WQ supervised and reviewed the report.
Supported by the Jinling Hospital Scientific Research Project, No. YYZD2021011 and No. 22JCYYZD1.
Institutional review board statement: This study protocol was approved by the Institutional Review Board of Jinling Hospital, No. 2021DZGZR-YBB-009.
Informed consent statement: This is a retrospective study, and patients were not required to give informed consent for the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors read and approved the final manuscript and declared no conflicts of interest.
Data sharing statement: The original anonymous dataset is available upon request from the corresponding author at
dingwei_nju@hotmail.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Wei-Wei Ding, MD, PhD, Professor, Surgeon, Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province, China.
dingwei_nju@hotmail.com
Received: April 28, 2023
Peer-review started: April 28, 2023
First decision: May 16, 2023
Revised: May 30, 2023
Accepted: June 21, 2023
Article in press: June 21, 2023
Published online: August 27, 2023
Processing time: 119 Days and 10.9 Hours
BACKGROUND
Few studies have addressed the question of which drain types are more beneficial for patients with pancreatic trauma (PT).
AIM
To investigate whether sustained low negative pressure irrigation (NPI) suction drainage is superior to closed passive gravity (PG) drainage in PT patients.
METHODS
PT patients who underwent pancreatic surgery were enrolled consecutively at a referral trauma center from January 2009 to October 2021. The primary outcome was defined as the occurrence of severe complications (Clavien-Dindo grade ≥ Ⅲb). Multivariable logistic regression was used to model the primary outcome, and propensity score matching (PSM) was included in the regression-based sensitivity analysis.
RESULTS
In this study, 146 patients underwent initial PG drainage, and 50 underwent initial NPI suction drainage. In the entire cohort, a multivariable logistic regression model showed that the adjusted risk for severe complications was decreased with NPI suction drainage [14/50 (28.0%) vs 66/146 (45.2%); odds ratio (OR), 0.437; 95% confidence interval (CI): 0.203-0.940]. After 1:1 PSM, 44 matched pairs were identified. The proportion of each operative procedure performed for pancreatic injury-related and other intra-abdominal organ injury-related cases was comparable in the matched cohort. NPI suction drainage still showed a lower risk for severe complications [11/44 (25.0%) vs 21/44 (47.7%); OR, 0.365; 95%CI: 0.148-0.901]. A forest plot revealed that NPI suction drainage was associated with a lower risk of Clavien-Dindo severity in most subgroups.
CONCLUSION
This study, based on one of the largest PT populations in a single high-volume center, revealed that initial NPI suction drainage could be recommended as a safe and effective alternative for managing complex PT patients.
Core Tip: Few studies have addressed the question of which drain types are more beneficial for patients with pancreatic trauma (PT). A total of 196 PT patients were selected from 2009 to 2021, of whom 146 underwent closed passive gravity (PG) drainage, and 50 underwent low negative pressure irrigation (NPI) suction drainage. In the entire cohort, multivariate analysis showed that the risk for severe complications (Clavien-Dindo grade ≥ Ⅲb) was decreased with NPI suction drainage. After 1:1 propensity score matching between the PG and NPI groups, the results were consistent with multivariate analysis.
