Impact of prophylactic drain placement on intra-abdominal infections after gastrectomy: nationwide inpatient database study in Japan.

[OBJECTIVE] This study aimed to evaluate the impact of drain placement on the incidence of postoperative complications in patients undergoing gastrectomy.

[BACKGROUND] The effectiveness of prophylactic abdominal drain placement in gastrectomy remains unclear. Nevertheless, they are still commonly used following gastrectomy.

[METHODS] We conducted a retrospective cohort study using a nationwide inpatient database in Japan. Patients who underwent gastrectomy for gastric cancer between January 2014 and March 2022 were included. We applied overlap weighting based on propensity scores to adjust for baseline characteristics. The primary outcome was the incidence of intra-abdominal infections. Secondary outcomes included postoperative percutaneous drainage, in-hospital death, length of hospital stay, and total hospitalization costs.

[RESULTS] A total of 217,750 patients met the inclusion criteria, and 196,660 (90.3%) received prophylactic abdominal drains. After overlap weighting, the drain group had a significantly lower incidence of intra-abdominal infections compared to the no-drain group (6.3% vs. 7.6%; 95% confidence interval [CI] - 1.7 to - 1.0). The prophylactic drains were also associated with reduced in-hospital postoperative mortality (0.6% vs. 0.8%; 95% CI - 0.3 to - 0.1). No significant differences were observed between the two groups in postoperative percutaneous drainage or hospital stay duration.

[CONCLUSION] This study suggests that prophylactic abdominal drainage was associated with a reduced incidence of intra-abdominal infections after gastrectomy without increasing hospitalization duration or medical costs.