Association of Prophylactic Abdominal Drain Placement With Short‐Term Postoperative Outcomes After Hepatectomy: A Nationwide Inpatient Database Study in Japan

ABSTRACT Aim Although randomized trials have discouraged routine prophylactic abdominal drainage after uncomplicated hepatectomy, these drains are still widely used in clinical practice. This study evaluated the association between prophylactic abdominal drain placement and short‐term outcomes after hepatic resection using a nationwide inpatient database. Methods We identified patients who underwent initial hepatic resection for liver tumors from the Japanese Diagnosis Procedure Combination database. Patients were classified into drain and no‐drain groups according to whether a prophylactic abdominal drain was placed intraoperatively. In‐hospital outcomes were compared using propensity score overlap weighting. Subgroup analyses were performed for intra‐abdominal infection and in‐hospital mortality. Results Among 73 613 eligible patients, 62 934 (85.5%) received prophylactic abdominal drains. After overlap weighting, the incidence of intra‐abdominal infection did not differ significantly between the drain and no‐drain groups (5.1% vs. 5.5%; risk difference, −0.3%; 95% confidence interval [CI], −0.8 to 0.1). Bile leakage, postoperative transfusion, postoperative drainage, and hospitalization costs were also comparable between groups. In contrast, prophylactic drain placement was associated with lower in‐hospital mortality (0.5% vs. 1.0%; risk difference, −0.6%; 95% CI, −0.8 to −0.4). Subgroup analyses showed that this association was more evident in patients with low body mass index and those treated at low‐ or middle‐volume hospitals. Conclusion Prophylactic abdominal drain placement after hepatic resection was not associated with a lower incidence of intra‐abdominal infection.