Drain use after open cholecystectomy: is there a justification?

Despite randomized trials showing no benefit, drain use after open cholecystectomy continues, perhaps as a result of more complicated patient presentation. We examined the reasons for drain use in patients undergoing open cholecystectomy and evaluated the effect of drain placement on surgical outcomes.

Univariate and multivariate analyses compared pre- and intraoperative factors associated with drain placement, and postoperative outcomes in patients undergoing open cholecystectomy at our institution between 2002 and 2007.

In 160 patients who underwent open cholecystectomy as primary operative procedure, 92 patients (58%) had a drain placed. In 22% of the cases, the surgeon’s stated reason for drain placement was hemorrhage, abscess, non-identification of critical structures, bile spillage, or concern for a bile leak. No reason was provided in78% of the operative reports. Multivariate analysis revealed diagnoses of acute, chronic, or gangrenous cholecystitis (n = 120, 75%), intraoperative bile spillage (n = 60, 38%), and higher than median intraoperative blood loss (>200 ml) as independent predictors of drain use (all p ≤ 0.042). Patients with drains had increased length of hospital stay, postoperative ICU admissions, rates of hospital re-admission, and use of post-operative endoscopy (all p ≤ 0.04). Patients with and without drains had similar rates of postoperative percutaneous drainage, bile leaks, intra-abdominal abscesses, wound infections, and deaths (all p ≥ 0.121).

The use of drains after open cholecystectomy was associated with complicated patient presentations: cholecystitis, intraoperative bile spillage, and high intraoperative blood loss. These patients had longer and more complicated postoperative course and more re-admissions. However, use of intraoperative drains was not associated with a reduction in the need for postoperative percutaneous drainage or in improvement in the rates of bile leaks, infections, or deaths.