No prophylactic drains in emergency abdominal surgery- a prospective, cohort study

Purpose It is still common practice to routinely place prophylactic intraperitoneal drains after abdominal emergency surgery, even though this practice has been abandoned in most elective abdominal interventions. International guidelines recommend against prophylactic drain placement, and the available evidence is inconclusive. We aimed to report the impact of an interventional, de-implementation strategy for prophylactic drain placement after emergency laparotomy/laparoscopy in Copenhagen University Hospital NOH, Denmark. Methods A prospective, single-center study included patients undergoing emergency abdominal surgery through one-year after implementing a no-prophylactic drain strategy compared to a historic cohort. Primary outcome was rate of intraperitoneal drain placement. Secondary outcomes were drain-indications, LOS, and 30-day complications. Results Overall, 1275 patients were included. Prophylactic drain-placement after emergency abdominal surgery was reduced from 15.7% in the control- to 4.5% of the interventional group, p < 0.001. No differences were observed in the secondary outcomes, including postoperative complications, and re-interventions. Specifically, there were no significant differences in postoperative wound infection rates (12.5% vs. 14.5%, p =0.374) or abscess formation requiring radiology drainage (6.6% vs. 4.9%, p =0.254). Furthermore, there was no difference in 30-day mortality in the intervention group compared to the historic control (11.4% vs. 11.5%, p =0.984). Conclusion An interventional, de-implementation strategy of avoiding prophylactic drains in emergency abdominal surgery was introduced and found to be a safe intraoperative approach, without an increased risk of severe postoperative complications.