Prophylactic drain placement after emergency general surgery procedures? A scoping review of the literature challenging common practice

Area of Science:

• General Surgery
• Surgical Outcomes
• Evidence-Based Medicine

Background:

• Mapping the literature on prophylactic drainage (PD) in Emergency General Surgery (EGS).
• Aiming to update clinical practice based on current evidence regarding PD use in EGS.

Purpose of the Study:

• To review and synthesize existing research on prophylactic drainage in Emergency General Surgery.
• To identify areas lacking sufficient evidence for clinical guideline development.

Main Methods:

• Conducted an exhaustive literature search across Embase, Medline, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials.
• Included literature published between January 2013 and December 2024.

Main Results:

• Most studies indicate superior outcomes in the no-drain group following EGS procedures.
• Prophylactic drainage may correlate with increased hospital stays, postoperative pain, and surgical site infections.
• Limited evidence exists for conditions like peritonitis and perforated ulcers, with some studies suggesting PD benefits.

Conclusions:

• Prophylactic drainage is generally not advised for most Emergency General Surgery cases.
• Evidence is scarce for conditions such as colorectal emergencies, necessitating further investigation.
• High-risk EGS cases may show improved outcomes with PD, warranting more research for guideline development.