Drain Management Pathway of McMillan et al for Reducing the Risk of Clinically Relevant Postoperative Pancreatic Fistula Following Pancreatoduodenectomy

Description

McMillan et al proposed a scheme for managing drains for a patient undergoing a pancreatoduodenectomy. This can help to avoid pancreatic fistula formation and other complications. The authors are from the University of Pennsylvania and the University of Verona.

Patient selection: pancreatoduodenectomy

Parameters:

(1) Fistula Risk Score (FRS) of Callery et al

(2) drainage fluid amylase on post-operative day 1 in U/L

(3) drainage appearance and other clinically relevant findings

The drainage appearance was considered sinister or benign. Additional clinically relavant factors that may impact a decision to remove a drain include postoperative bleeding, hemodynamic instability, bile leak, chyle leak or abscess formation.

FRS	Drainage Fluid Amylase	Risk Factors for Complications	Action
<= 2 (low risk)	NA	NA	no drain placed at surgery
>= 3 (not low risk)	<= 5,000 U/L	absent	remove drain on POD 3
>= 3	> 5,000	NA	remove at surgeon’s discretion
>= 3	NA	present	remove at surgeon’s discretion

If the drain is to be removed at the surgeon’s discretion, then it should be pulled as early as possible.

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Drain Management Pathway of McMillan et al for Reducing the Risk of Clinically Relevant Postoperative Pancreatic Fistula Following Pancreatoduodenectomy

Description

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