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Regular vs. selective use of closed suction drains following robot-assisted radical prostatectomy: results from a regional quality improvement collaborative

Prostate Cancer and Prostatic Diseases volume 23, pages 151–159 (2020)Cite this article

Subjects

Abstract

Background

Closed suction drain (CSD) placement is common in robot-assisted radical prostatectomy (RARP). Our goal is to quantify outcomes of RARP for patients undergoing RARP by surgeons who regularly or selectively use CSDs.

Methods

Patients undergoing RARP (4/2014−7/2017) were prospectively entered into the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry. Outcomes included length of stay (LOS) >2 days, >16-day catheterization, 30-day readmission, and clinically significant urine leak or ileus. Retrospective analysis of each adverse event was performed comparing groups using chi-square tests.

Results

In all, 6746 RARPs were performed by 115 MUSIC surgeons. CSDs were used in 4451 RARP (66.0%), with wide variation in surgeon CSD use (median: 94.7%, range: 0–100%, IQR: 45–100%). The cohorts of patients treated by surgeons with regular vs. selective CSD usage were similar. CSD use pattern was not associated with rates of prolonged catheterization (4.6% vs. 3.9%, p = 0.17) or readmission (4.5% vs. 4.0%, p = 0.35) and multivariable analysis confirmed these findings (each p > 0.10). Regular CSD use was associated with LOS >2 days (8.4% vs. 6.3%, p = 0.001) and multivariable analyses indicated an odds ratio (OR) of 1.42 (95% CI: 1.12–1.79; p = 0.017) and increased likelihood of clinically significant ileus (OR: 1.64; CI: 1.14–2.35; p = 0.008).

Conclusions

Although there are specific situations in which CSDs are beneficial, e.g. anastomotic leak or observed lymphatic drainage, regular CSD use during RARP was associated with a greater likelihood of LOS >2 days and clinically significant ileus. Our data suggest that CSD should be placed selectively rather than routinely after RARP.

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Acknowledgements

The corresponding author would like to thank the Betz Family Endowment for Cancer Research for their continued support. Funding was provided in part by the Spectrum Health Foundation and from Blue Cross Blue Shield of Michigan. We also would like to thank Sabrina Noyes for administrative support.

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Authors and Affiliations

  1. Michigan State University College of Human Medicine, Grand Rapids, MI, USA

    Samer W. Kirmiz & Brian R. Lane

  2. Spectrum Health Hospital System, Grand Rapids, MI, USA

    Stephen Babitz, Christopher M. Brede & Brian R. Lane

  3. Department of Urology, University of Michigan, Ann Arbor, MI, USA

    Susan Linsell, Ji Qi, David C. Miller & James E. Montie

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  1. Samer W. Kirmiz
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for the Michigan Urological Surgery Improvement Collaborative

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Correspondence to Brian R. Lane.

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Kirmiz, S.W., Babitz, S., Linsell, S. et al. Regular vs. selective use of closed suction drains following robot-assisted radical prostatectomy: results from a regional quality improvement collaborative. Prostate Cancer Prostatic Dis 23, 151–159 (2020). https://doi.org/10.1038/s41391-019-0170-1

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