Summary of findings for the main comparison. Intra‐abdominal drainage compared with no drainage for elective colorectal surgery.
| Intra‐abdominal drainage compared with no drainage for elective colorectal surgery | |||||
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Patient or population: unselected population undergoing elective colorectal anastomosis Settings: high resource settings Intervention: intra‐abdominal drainage Comparison: no drainage | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| No drainage | Intra‐abdominal drainage | ||||
| Anastomotic dehiscence | Unselected population undergoing elective colorectal anastomosis | RR 1.40 (0.45 to 4.40) | 809 (2) | ⊕⊕⊝⊝ low | |
| 12 per 1000* |
17 per 1000 (5 to 52.8) |
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| Mortality | Unselected population undergoing elective colorectal anastomosis | RR 0.77 (0.41 to 1.45) | 908 (3) | ⊕⊕⊝⊝ low | |
| 46 per 1000* |
47 per 1000 (19 to 67) |
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| *The basis for the assumed risk (e.g. the median control group risk) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio. | |||||
| GRADE Working Group grades of evidence (www. gradepro.org) High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
Assumed risk: anastomotic dehiscence occurred 5 times in 406 participants in the no drainage (control) group. Mortality occurred 21 times in 454 participants in the no drainage (control) group.
The evidence was downgraded to low quality according to GRADE methods; there was substantial clinical heterogeneity and further research in current laparoscopic colorectal practice is very likely to have an important impact on our confidence in the estimate of effect of drainage. In addition, there was a low event rate for anastomotic leak and mortality within the studies assessed, which may not accurately reflect current clinical estimates.