Association of Prophylactic Abdominal Drain Placement With Short-Term Postoperative Outcomes After Hepatectomy: A Nationwide Inpatient Database Study in Japan.
14 affiliations
- 1Department of Surgery National Defense Medical College Saitama Japan.
- 2Department of Health Services Research, Graduate School of Medicine The University of Tokyo Tokyo Japan.
- 3Department of Hepatobiliary-Pancreatic and Gastrointestinal Surgery International University of Health and Welfare School of Medicine Chiba Japan.
- 4Department of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo Tokyo Japan.
- 5Center for Next Generation of Community Health Chiba University Hospital Chiba Japan.
- 6Department of Infectious Diseases Hiroshima University Hospital Hiroshima Japan.
- 7Department of Surgery, Division of Gastroenterological Surgery Sapporo Medical University Sapporo Japan.
- 8Department of Cardiovascular Surgery Kawasaki Medical School Okayama Japan.
- 9Department of Surgery Toho University Ohashi Medical Center Tokyo Japan.
- 10Department of Gastroenterological Surgery, Graduate School of Medicine The University of Osaka Osaka Japan.
- 11Department of Surgery Keio University School of Medicine Tokyo Japan.
- 12Department of Surgery Nippon Medical School Tama Nagayama Hospital Tokyo Japan.
- 13Division of Clinical Laboratory and Infection Control Yamagata University Hospital Yamagata Japan.
- 14Department of Emergency and Critical Care Medicine Keio University School of Medicine Tokyo 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.
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BibTeX
@article{kouzu2026association,
title = {{Association of Prophylactic Abdominal Drain Placement With Short-Term Postoperative Outcomes After Hepatectomy: A Nationwide Inpatient Database Study in Japan.}},
author = {Keita Kouzu and Shotaro Aso and Yuki Hirano and Hiroki Matsui and Kensuke Yoshimura and Hiroki Kitagawa and Toru Kato and Naoki Yamane and Osahiko Hagiwara and Norikatsu Miyoshi and Satoru Matsuda and Hiroshi Maruyama and Keita Morikane and Junichi Sasaki and Hideo Yasunaga and Yuko Kitagawa and Manabu Watanabe and Hironori Tsujimoto},
journal = {Annals of gastroenterological surgery},
year = {2026},
month = oct,
doi = {10.1002/ags3.70299},
url = {https://europepmc.org/article/MED/42903240},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association of Prophylactic Abdominal Drain Placement With Short-Term Postoperative Outcomes After Hepatectomy: A Nationwide Inpatient Database Study in Japan.
AU - Keita Kouzu
AU - Shotaro Aso
AU - Yuki Hirano
AU - Hiroki Matsui
AU - Kensuke Yoshimura
AU - Hiroki Kitagawa
AU - Toru Kato
AU - Naoki Yamane
AU - Osahiko Hagiwara
AU - Norikatsu Miyoshi
AU - Satoru Matsuda
AU - Hiroshi Maruyama
AU - Keita Morikane
AU - Junichi Sasaki
AU - Hideo Yasunaga
AU - Yuko Kitagawa
AU - Manabu Watanabe
AU - Hironori Tsujimoto
PY - 2026
DA - 2026/10/19
JO - Annals of gastroenterological surgery
DO - 10.1002/ags3.70299
UR - https://europepmc.org/article/MED/42903240
AB - 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.
SN - 2475-0328
ER -