• Sebastian Hempel, Pamela Püttmann, Christoph Kahlert, Lena Seifert, Sören Torge Mees, Thilo Welsch, Jürgen Weitz, and Marius Distler.
• Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Deutschland.
• Zentralbl Chir. 2018 Jun 1; 143 (3): 270-277.

IntroductionPostoperative pancreatic fistula (POPF) is a common complication after pancreatic surgery and is associated with extended hospitalisation, increased medical costs, and reduced quality of life. The aim of the present study was to assess the treatment of POPF in Germany, with a special focus on outpatient drain management in patients with clinically relevant POPF (CR-POPF).MethodsA questionnaire evaluating postoperative management once a CR-POPF is diagnosed - especially focusing on ambulatory drain management - was developed and sent to 211 German hospitals performing > 12 pancreatic operations per year. Statistical analysis was carried out using SPSS 21.ResultsThe final response rate was 62% (n = 131). Outpatient drainage management is performed by most of the responding hospitals (n = 100, 76.3%). However, 30% of hospitals (n = 40) perform outpatient treatment only in 5% of their cases with clinically relevant POPF. There was no correlation between case load of the pancreatic centres and frequency of outpatient drain management. In general, discharge criteria for patients with drained POPF (n = 98, 74.8%), the drain management itself (n = 95, 72.5%) and criteria for drain removal (n = 74, 56.5%) are not standardised but made individually. In centres with standardised drain management criteria for drain removal, these criteria were drain volume < 20 ml (29.8%), no fluid collection (25.2%), no elevation of drain amylase/lipase (25.2%) and no specific symptoms (22.1%).ConclusionThis is the first survey in Germany evaluating outpatient drain management in patients with CR-POPF. Although the data in the literature are rare, the majority of German pancreatic surgeons perform outpatient drain management. However, discharge criteria, outpatient care and drain removal are standardised in only the minority of centres. Therefore, we recommend the evaluation of discharge criteria and a management algorithm for patients with drained CR-POPF to improve the perioperative course.Georg Thieme Verlag KG Stuttgart · New York.

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