Efficacy of Abdominal Drains in Reducing Post-Operative Complications in Patients Undergoing Elective Colorectal Surgery

Aim: Abdominal drainage is believed to be prophylactic against accumulation of fluid and an early indicator of anastomotic leakage. However, evidence for this role remains equivocal. Our study aims to study the efficacy of abdominal drains in reducing post-operative complications in patients undergoing elective colorectal surgery. Method: The study is a retrospective non-interventional cohort study which involved adults undergoing elective colorectal surgery from 19 January 2021 to 22 February 2022. The main outcomes measured were fever, ileus, surgical site infections (SSI), pulmonary complications, venous thromboembolism (VTE), 30-day mortality, anastomotic leakage (AL), need for re-intervention, Post-Operative Days (POD) to pass flatus and feces and length of hospital stay (LOS). Categorical variables were analysed using Fisher's exact test and continuous variables were analysed using Mann Whitney U test. Results: 44 patients were included (38.6% female, 84.1% Chinese, mean age 74.18 years). The majority patients, 41 (93.2%), underwent surgery for cancer. 29 (65.9%) patients received abdominal drainage. There was no significant difference between the no drain and drain groups for fever (p=0.135), ileus (p=0.452), SSI (p=1.000), pulmonary complications (p=1.000), VTE (p=1.000), 30-day mortality (p=1.000), clinical AL (p=1.000), radiological AL (p=1.000), non-surgical re-intervention (p=0.488), surgical re-intervention (p=1.000), POD to pass flatus (p=0.258), POD to pass feces (p=0.984) and LOS (p=0.096). Conclusion: Abdominal drainage after elective colorectal surgery does not reduce the development of post-operative complications. The routine use of abdominal drainage can be avoided to minimise risk to patients. Further well-controlled Randomised Controlled Trials (RCTs) should be conducted to consolidate the evidence.