Italian survey about intraperitoneal drain use in distal pancreatectomy

Intraperitoneal prophylactic drain (IPD) use in distal pancreatectomy (DP) is still controversial. A survey was carried out through the Italian community of pancreatic surgeons using institutional emails, Twitter, and Facebook accounts of the Italian Association for the Study of the Pancreas (AISP) and the Italian Association of Hepato-biliary-pancreatic Surgery (AICEP). The survey was structured to learn surgeons' practice in using IPD through questions and one clinical vignette. Respondents were asked to report their regrets for omission and commission regarding the IPD use for the clinical scenario, eliciting a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were built to identify respondents' attitudes. One hundred six surgeons completed the survey. Sixty-three (59.4%) respondents confirmed using at least 1 drain, while 43 (40.6%) placed 2 IPDs. Only 13 respondents (12.3%) declared a change in IPD strategy in patients at high risk of clinically relevant postoperative pancreatic fistula (CR-POPF), while 9 (9.4%) respondents changed their strategy in low-risk POPF situations. Thirty-five (35.5%) respondents declared they would remove the IPD within the third postoperative day (POD) in the absence of CR-POPF suspicion. The median omission regret, which proved to be the wrong decision, was 80 (50-100, IQR). The median regret due to the commission of IPD, which turned out to be useless, was 2.5 (1-20, IQR). The CR-POPF probability threshold at which drainage omission was the less regrettable choice was 7% (1-35, IQR). The threshold to perceive drain omission as the least regrettable choice was higher in female surgeons (P < 0.001), in surgeons who modulated the strategies based on the risk of CR-POPF, and in high volume centers (p = 0.039). The threshold was lower in surgeons who performed minimally invasive distal pancreatectomy (P < 0.001), adopted a closed system (P < 0.001), placed two IPDs (P < 0.001), or perceived the IPD as important to prevent reintervention (p = 0.047). Drain management after DP remains very heterogeneous among surgeons. The regret model suggested that IPD omission could be performed in low-risk patients (7% of CR-POPF), leading to low regret in the case of the wrong decision, making it an acceptable clinical decision.

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Journal
Updates in Surgery
Published
2024-10-13
DOI
https://doi.org/10.1007/s13304-024-01987-0
Citations
6
Primary Topic
Pancreatic and Hepatic Oncology Research
Type
article
Field-Weighted Citation Impact
1.70
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article

Italian survey about intraperitoneal drain use in distal pancreatectomy

Di Stefano, Mocchegiani Federico, Marcello De Luca, Cescon Matteo et al.
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Italian survey about intraperitoneal drain use in distal pancreatectomy

Di Stefano, Mocchegiani Federico, Marcello De Luca, Cescon Matteo, Claudio Ricci, Di Sebastiano Pierluigi, Nicolò Pecorelli, L. Raffaele, G. De Tommaso, Laura Alberici, Isabella M. Frigerio, Napoli Niccolò, Rosanna De Marco, Luiz Carlos Giuliano, Ettorre Giuseppe Maria, D. Di Tommaso, Barraco Elisa, Picchi Davide, Baiocchi Gianluca, M. Di Stefano, Alessandro Cucchetti, Isidoro Di Carlo, Zanus Giacomo, Memeo Riccardo, Rocca Aldo, Salvatore Gruttadauria, Fernando Antônio, Giovanni Capretti, Cristina Damiano, Stefano Crippa, Ugo Boggi, Massimo Alessio, De Carlis Luciano, Matteo Barabino, Giovanna Di Meo, Alessandro Esposito, Gianotti Luca, Massimo Falconi, Domenico Tamburrino, Roberto Coppola, Allegrini Alessandro, Stefano Partelli, Mazzola Michele, Citterio Davide, P. Alberto, Patrono Damiano, Roberto Salvia, Alessandro Zerbi, Carla Ettore, Bruno Nardo, Luigi Veneroni, Diego Fernando López Donato, T Bruna, A. De Marco, P Evangelista Enrico, Francesco Izzo, Di Benedetto Fabrizio, Caccamo Lucio, Zanello Matteo, Zingaretti Caterina Costanza, Giovanni Butturini, Mazzaferro Vincenzo, Giacomo Batignani, Casadei Riccardo, Marchegiani Giovanni, Aleotti Francesca, Troisi Roberto, Vivarelli Marco, Massani Marco, Giuliante Felice, F. Alessandro, Serenari Matteo, Maggino Laura, M.L. Sánchez Lorenzo, A. Sérgio, María Laura, Malleo Giuseppe, Zironda Andrea, Campra Donata, De Luca Raffaele, Del Vecchio Antonella, Della Valle Raffaele, Langella Serena, Lionetto Gabriella, Milanetto Anna Caterina, Nappo Gennnaro, Paiella Salvatore, Puglisi Silvana, Scialantrone Grazisa, Belfiori Giulio, Gavazzi Francesco, Belli Giulio, Bonatti Chiara, Grazi Gianluca, Moro Francesco, Ravaioli Matteo, Ruzzente Andrea, Sacco Luca, Belli Andrea, Colledan Michele
article en
6 citations

Abstract

Intraperitoneal prophylactic drain (IPD) use in distal pancreatectomy (DP) is still controversial. A survey was carried out through the Italian community of pancreatic surgeons using institutional emails, Twitter, and Facebook accounts of the Italian Association for the Study of the Pancreas (AISP) and the Italian Association of Hepato-biliary-pancreatic Surgery (AICEP). The survey was structured to learn surgeons' practice in using IPD through questions and one clinical vignette. Respondents were asked to report their regrets for omission and commission regarding the IPD use for the clinical scenario, eliciting a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were built to identify respondents' attitudes. One hundred six surgeons completed the survey. Sixty-three (59.4%) respondents confirmed using at least 1 drain, while 43 (40.6%) placed 2 IPDs. Only 13 respondents (12.3%) declared a change in IPD strategy in patients at high risk of clinically relevant postoperative pancreatic fistula (CR-POPF), while 9 (9.4%) respondents changed their strategy in low-risk POPF situations. Thirty-five (35.5%) respondents declared they would remove the IPD within the third postoperative day (POD) in the absence of CR-POPF suspicion. The median omission regret, which proved to be the wrong decision, was 80 (50-100, IQR). The median regret due to the commission of IPD, which turned out to be useless, was 2.5 (1-20, IQR). The CR-POPF probability threshold at which drainage omission was the less regrettable choice was 7% (1-35, IQR). The threshold to perceive drain omission as the least regrettable choice was higher in female surgeons (P < 0.001), in surgeons who modulated the strategies based on the risk of CR-POPF, and in high volume centers (p = 0.039). The threshold was lower in surgeons who performed minimally invasive distal pancreatectomy (P < 0.001), adopted a closed system (P < 0.001), placed two IPDs (P < 0.001), or perceived the IPD as important to prevent reintervention (p = 0.047). Drain management after DP remains very heterogeneous among surgeons. The regret model suggested that IPD omission could be performed in low-risk patients (7% of CR-POPF), leading to low regret in the case of the wrong decision, making it an acceptable clinical decision.

Updates in SurgeryVol. 77(1)
University of Pisa (IT), University of Verona (IT), Humanitas University (IT), Vita-Salute San Raffaele University (IT), Casa di Cura Villa Garda (IT), Ospedale G.B. Morgagni - L.Pierantoni (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), University of Bologna (IT)
Good health and well-being
Openalex Percentile: Top 13%
Pancreatic and Hepatic Oncology Research
1.70
DOIOpen Access PDFOpenAlex
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