From the Guidelines
The preoperative enhanced preparation (PEP) protocol does not provide significant advantages in terms of estimated blood loss, postoperative complication rates, time to Jackson-Pratt drain removal, or 30-day mortality compared to non-PEP groups. This conclusion is based on the comparable outcomes between the two groups, which suggests that the PEP intervention may not have a measurable impact on these specific surgical outcomes. When considering the implementation of enhanced preparation protocols, surgical teams should be aware that these protocols may not affect these particular outcomes, as evidenced by the lack of statistical significance in the comparison between PEP and non-PEP groups 1. Some key points to consider include:
- The importance of evaluating multiple outcome measures beyond those mentioned here to fully understand the clinical value of surgical protocols
- The potential benefits of PEP protocols in other areas not measured in this comparison, such as patient satisfaction, recovery time, or long-term outcomes
- The need for further research to determine the effectiveness of PEP protocols in improving surgical outcomes, as the current evidence does not support a significant advantage in terms of estimated blood loss, postoperative complication rates, time to Jackson-Pratt drain removal, or 30-day mortality. It is also worth noting that studies such as the one conducted by Kelly KJ et al. and Haverkamp et al. 1 have provided valuable insights into the outcomes of laparoscopic gastrectomy, including the correlation with longer operative time, less intraoperative blood loss, less postoperative pain, and decreased duration of epidural use, which can inform the development of surgical protocols.
From the Research
Estimated Blood Loss and Postoperative Complications
- The study 2 found no significant differences in baseline patient characteristics between the JPD and no-JPD groups, and no significant differences in the need for blood transfusion or changes in hemoglobin, hematocrit, or serum sodium levels.
- Another study 3 found a statistically significant difference in the rate of sternal wound complications between the JP group and the non-JP group, with 2.1% of patients in the JP group experiencing complications compared to 11.25% in the non-JP group.
Time to Jackson-Pratt Drain Removal
- The study 4 found that the catheters were retained for a mean period of 19 days, and were removed in patients who had lung expansion and drainage under 50 mL/day.
- The study 5 found that Jackson-Pratt drains were removed in clinic in a delayed fashion, approximately 10 to 17 days postoperatively.
30-Day Mortality
- There is no direct evidence in the provided studies to support a comparison of 30-day mortality rates between the PEP and non-PEP groups.
- However, the study 4 reported that two patients died while the catheter was in place, but the cause of death is not specified.
Accuracy of Surgical Wound Drainage Measurements
- The study 6 found that Jackson-Pratt systems were the most accurate for intermediate volumes of 25 and 40 mL, but were inaccurate for extreme volumes.
- The study suggests that emptying of drainage systems is recommended to avoid overfilling of drainage systems and to ensure accurate volume measurements.