Li KW, Wang K, Hu YP, Yang C, Deng YX, Wang XY, Liu YX, Li WQ, Ding WW. Initial suction drainage decreases severe postoperative complications after pancreatic trauma: A cohort study. World J Gastrointest Surg 2023; 15(8): 1652-1662 [PMID: 37701705 DOI: 10.4240/wjgs.v15.i8.1652]
Corresponding Author of This Article
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
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which 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: http://creativecommons.org/licenses/by-nc/4.0/
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 bythe 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
ARTICLE HIGHLIGHTS
Research background
Consensus regarding the necessity for drainage has been formulated in the many management strategies for pancreatic trauma (PT).
Research motivation
Few studies have addressed the question of which drain types are more beneficial for PT patients.
Research objectives
To investigate whether sustained low negative pressure irrigation (NPI) suction drainage is superior to closed passive gravity (PG) drainage in PT patients.
Research methods
We performed a retrospective cohort study of consecutive patients who underwent pancreatic surgery at a tertiary trauma referral center between January 2009 and October 2021 in our PT database. 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.
Research 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].
Research conclusions
Initial NPI suction drainage could be recommended as a safe and effective alternative for managing complex PT patients.
Research perspectives
Further randomized, controlled trials are warranted to validate these results.
