Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort
Authors: Guadagni Stefano , Catarci Marco , Masedu Francesco , Karim Mohammad Ehsanul , Clementi Marco , Ruffo Giacomo , Viola Massimo Giuseppe , Borghi Felice , Baldazzi Gianandrea , Scatizzi Marco , Pirozzi Felice , Delrio Paolo , Garulli Gianluca , Marini Pierluigi , Campagnacci Roberto , De Luca Raffaele , Ficari Ferdinando , Sica Giuseppe , Scabini Stefano , Liverani Andrea , Caricato Marco , Patriti Alberto ,   the Italian ColoRectal Anastomotic Leakage (iCral) study group, Mancini Stefano , Baiocchi Gian Luca , Santoro Roberto , Siquini Walter , Guercioni Gianluca , Basti Massimo , Pedrazzani Corrado , Totis Mauro , Carrara Alessandro , Lucchi Andrea , Pavanello Maurizio , Muratore Andrea , D’Ugo Stefano , Leo Alberto Di , Pignata Giusto , Elmore Ugo , Anania Gabriele , Carlini Massimo , Corcione Francesco , Vettoretto Nereo , Longo Graziano , Sorrentino Mario , Giuliani Antonio , Ferrari Giovanni , Taglietti Lucio , Verzelli Augusto , Cosmo Mariantonietta Di , Cavaliere Davide , Milone Marco , Rausei Stefano , Ciaccio Giovanni , Tebala Giovanni , Brisinda Giuseppe , Berti Stefano , Millo Paolo , Boni Luigi , Guerrieri Mario , Persiani Roberto , Parini Dario , Spinelli Antonino , Genna Michele , Bottino Vincenzo , Coratti Andrea , Scala Dario , Rivolta Umberto , Piccoli Micaela , Talarico Carlo , Roviello Franco , Anastasi Alessandro , Ettorre Giuseppe Maria , Montuori Mauro , Mariani Pierpaolo , de Manzini Nicolò , Donini Annibale , Armellino Mariano Fortunato , Feo Carlo , Guerriero Silvio , Costanzi Andrea , Marchesi Federico , Cicetti Moreno , Ciano Paolo , Benedetti Michele , Montemurro Leonardo Antonio , Mattei Maria Sole , Belloni Elena , Apa Daniela , Carlo Matteo Di , Bertocchi Elisa , Masini Gaia , Altamura Amedeo , Rubichi Francesco , Cianflocca Desirée , Migliore Marco , Cassini Diletta , Pandolfini Lorenzo , Falsetto Alessandro , Sciuto Antonio , Pace Ugo , Bucci Andrea Fares , Monari Francesco , Attinà Grazia Maria , Maurizi Angela , Simone Michele , Giudici Francesco , Cianchi Fabio , Sensi Bruno , Aprile Alessandra , Soriero Domenico , Scarinci Andrea , Capolupo Gabriella Teresa , Sisti Valerio , Ricci Marcella Lodovica , Sagnotta Andrea , Molfino Sarah , Amodio Pietro , Cardinali Alessandro , Cicconi Simone , Marziali Irene , Frazzini Diletta , Conti Cristian , Tamini Nicolò , Braga Marco , Motter Michele , Tirone Giuseppe , Martorelli Giacomo , Cacurri Alban , Marco Carlo Di , Marsanic Patrizia , Federico Nicoletta Sveva Pipitone , Spampinato Marcello , Crepaz Lorenzo , Andreuccetti Jacopo , Canfora Ilaria , Maggi Giulia , Chiozza Matteo , Spoletini Domenico , Marcellinaro Rosa , Bracale Umberto , Peltrini Roberto , Nuzzo Maria Michela Di , Botteri Emanuele , Santoni Simone , Stefanoni Massimo , Del Vecchio Giovanni , Magistro Carmelo , Ruggiero Silvia , Birindelli Arianna , Budassi Andrea , Zigiotto Daniele , Solaini Leonardo , Ercolani Giorgio , De Palma Giovanni Domenico , Tenconi Silvia , Locurto Paolo , Cintio Antonio Di , Chiarello Maria Michela , Cariati Maria , Gennai Andrea , Grivon Manuela , Cassinotti Elisa , Ortenzi Monica , Biondi Alberto , De Luca Maurizio , Carrano Francesco , Fior Francesca , Ferronetti Antonio , Giuliani Giuseppe , Marino Graziella , Bertoglio Camillo Leonardo , Pecchini Francesca , Greco Vincenzo , Piagnerelli Roberto , Canonico Giuseppe , Colasanti Marco , Pinotti Enrico , Carminati Roberta , Osenda Edoardo , Graziosi Luigina , De Martino Ciro , Ioia Giovanna , Pindozzi Fioralba , Organetti Lorenzo , Monteleone Michela , Dalmonte Giorgio , Gioia Gabriele La 
Published: January 2024

Abstract

Background
In Italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. The aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery.

Methods
A database was retrospectively analysed through a 1:1 propensity score-matching model including 21 covariates. The primary endpoint was the postoperative duration of stay, and the secondary endpoints were surgical site infections, infectious morbidity rate defined as surgical site infections plus pulmonary infections plus urinary infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation and mortality rates. The results of multiple logistic regression analyses were presented as odds ratios (OR) and 95 per cent c.i.

Results
A total of 6157 patients were analysed to produce two well-balanced groups of 1802 patients: group (A), no abdominal drain(s) and group (B), abdominal drain(s). Group A versus group B showed a significantly lower risk of postoperative duration of stay &gt;6 days (OR 0.60; 95 per cent c.i. 0.51–0.70; P &lt; 0.001). A mean postoperative duration of stay difference of 0.86 days was detected between groups. No difference was recorded between the two groups for all the other endpoints.

Conclusion
This study confirms that placement of abdominal drain(s) after elective colorectal surgery is associated with a non-clinically significant longer (0.86 days) postoperative duration of stay but has no impact on any other secondary outcomes, confirming that abdominal drains should not be used routinely in colorectal surgery.