Time to Abdominal Percutaneous Drain Placement is Not Associated with Complication

Author(s):
Jacob O’Dell; Andrew Dulek; Matthew Johnson; Aaron Rohr; Robert Winfield; Christopher Guidry

Background:

Percutaneous drains, typically placed by interventional radiology (IR), are used to treat a variety of intra-abdominal processes, including infection. Increasing time to source control has been shown to predict worse outcomes in patients with intra-abdominal infections, but it is unclear whether this relationship is valid when the source control method is percutaneous drainage.

Hypothesis:

Time from diagnostic imaging to drain placement will be associated with higher complication rates in a population of patients requiring IR percutaneous drainage for intra-abdominal, retroperitoneal, or pelvic processes.

Methods:

Single institution, retrospective, case-control study. We identified all adult patients who received an IR placed percutaneous drain in the abdomen, retroperitoneum or pelvis from 2020-2021. We excluded peritoneal drains for ascites, biliary decompressions, urinary decompressions, and outpatient procedures. Demographics, comorbidities, and SOFA scores were collected.  Multiple organ failure (MOF) was defined as derangement of two or more organ systems with a SOFA score of at least 3. The time interval from imaging to drain placement was also recorded. Patients were stratified based on our composite complication variable defined as the occurrence of any of the following: in-hospital mortality, subsequent IR drainage procedures, hospital readmission within 30 days of discharge, or surgery for same disease process within 30 days of drain placement. Standard statistical analysis and multiple logistic regression was performed.

Results:

184 patients were included, 94 of which developed a complication (51.1%). Time from imaging read to drain placement did not differ between the complication and non-complication groups (median 21 hours [IQR 16.9-31.1] vs. 23.9 hours [16.7-31.1]; p=0.27). 41 patients (22.3%) presented with MOF. Controlling for age, sex, comorbidity burden, immunosuppression status, and multi-organ failure (MOF), the time from imaging performance to drain placement was not associated with complication (OR 1.0; 95% CI: 0.98-1.01; p=0.48).

Conclusions:

Time from diagnosis to percutaneous drain placement did not differ between patients with and without complications from their disease. The urgency of percutaneous drain placement should continue to be explored, with ramifications on patient outcomes and healthcare resource utilization.