Comparison of Drain Versus No Drains in Abdominal Surgery- Impact on Morbidity and Recovery

Abstract

Background: The role of prophylactic drains in abdominal surgery remains controversial, with conflicting evidence regarding their benefit in preventing postoperative complications. Modern surgical philosophies, particularly Enhanced Recovery After Surgery (ERAS) pathways, advocate minimal use of drains to enhance patient comfort and reduce hospital stay. This study aimed to compare postoperative morbidity, recovery, and cost outcomes between patients undergoing abdominal surgery with and without drain placement.

Methods: A prospective comparative observational study was conducted on 120 patients undergoing elective or emergency abdominal surgeries at a tertiary-care center. Patients were divided into two groups-Drain group (n = 60) and No-drain group (n = 60)-based on intraoperative decision. Postoperative parameters including surgical site infection (SSI), intra-abdominal collection, pain scores, time to ambulation, oral intake, bowel activity, length of hospital stay, and direct treatment costs were recorded and statistically analyzed using chi-square and Welch t-tests.

Results: Composite morbidity within 30 days was 36.7 % in the drain group and 23.3 % in the no-drain group (p = 0.084). Rates of SSI (31.7 % vs 18.3 %) and intra-abdominal collections (13.3 % vs 10.0 %) did not differ significantly. However, the no-drain group exhibited significantly lower postoperative pain (VAS at 24 h = 4.9 ± 1.1 vs 5.8 ± 1.2; p < 0.001), earlier ambulation (18.9 ± 5.9 h vs 22.7 ± 6.8 h; p = 0.001), shorter hospital stay (5.1 ± 1.8 days vs 6.2 ± 2.1 days; p = 0.002), higher comfort and quality-of-recovery scores, and lower mean hospital cost (₹ 33,140 ± 8,900 vs ₹ 38,720 ± 9,800; p = 0.0009).

Conclusion: Routine drain placement after abdominal surgery offers no significant reduction in postoperative complications and may delay recovery. Omission of drains facilitates early mobilization, improved comfort, shorter hospitalization, and cost savings without increasing morbidity. Selective use of drains based on intraoperative findings is recommended over a universal approach.