EP541 - Outcomes of Drain Retention vs. Removal Before Diverticular Surgery in Patients with Complicated Sigmoid Diverticulitis: A Multi-center Retrospective Study

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Purpose/Background: Interventional radiology drain placement is commonplace for patients with complicated diverticular disease with abscess. However, to our knowledge, there is no standard of care in relation to drain retention vs. drain removal prior to diverticular surgery (Appendix 1). Most patients who undergo drain placement have the drain removed prior to surgery. But these patients may have recurrent abscesses which require a second drain to be placed, further delaying their surgery. This retrospective analysis compares outcomes of drain retention vs drain removal prior to diverticular surgery. Is there any benefit in keeping the drains until the time of surgery to prevent recurrent abscesses?

Methods/Interventions: All adult patients (aged over 18) with complicated diverticular disease requiring drain placement across the three NYU Langone Health campuses were evaluated using electronic medical records from 2019 to 2024. Baseline data collected included sex, age, ASA classification, BMI, smoking status, colonoscopy status, abscess recurrence, repeat drainage, diverticulitis surgery status, duration of drain presence, time from drain removal to surgery, and mortality. We compared clinical outcomes between two groups: (1) patients who retained the drain until surgery, and (2) those who had the drain removed prior to surgery. Continuous variables were analyzed using a two-sample t-test, while categorical variables were compared with a chi-square test. Primary outcomes included post-surgical complications, length of hospital stay, abscess recurrence, and mortality.

Results/Outcomes: A total of 72 patients who underwent drain insertion were included in this study. Of these, 67% (n=48) patients had surgery for diverticulitis, with 56% (n=27) having the drain in place at the time of surgery, and 44% (n=21) having the drain removed beforehand. The median hospital stay was 5 days. Four patients required a second drain insertion before surgery, but the sample size was insufficient for subgroup analysis. We assessed the impact of drain removal during surgery and conducted a chi-square test to evaluate abscess recurrence, post-surgery complications, and mortality, along with a t-test for post-surgery length of stay. No significant differences were observed in these outcomes between the two groups.

Conclusion/Discussion: In this multicenter retrospective study, no significant differences were found in clinical outcomes between patients who retained their drain until the time of diverticulitis surgery and those who had the drain removed prior to surgery. These findings suggest that retaining the drain until surgery may not confer a measurable benefit in preventing abscess recurrence or improving post-operative outcomes. Further studies with larger sample sizes are warranted to explore any potential advantages of drain management strategies in this patient population.