Factors Associated with Drain Placement and Postoperative Outcomes After Laparoscopic Cholecystectomy: A Retrospective Single-center Cohort Study

Objective: This study aimed to identify preoperative and intraoperative factors associated with selective drain placement during laparoscopic cholecystectomy and to describe early postoperative outcomes in patients with and without drains.Methods: This retrospective single-center cohort study included adults who underwent laparoscopic cholecystectomy between January 1, 2023, and July 31, 2025.Patients were grouped according to drain placement.Demographic, clinical, laboratory, radiological, intraoperative, and 30-day postoperative data were reviewed.Independent associations between factors and drain placement were assessed using multivariable logistic regression.Postoperative group comparisons were secondary, unadjusted, and descriptive.Results: Of the 2,800 patients, 556 (19.9%) received a drain and 2,244 (80.1%) did not.The drain group had higher rates of acute cholecystitis, Tokyo grade I-III disease, gallbladder wall thickening, pericholecystic fluid, stone impaction, and emergency surgery, and had higher white blood cell counts, C-reactive protein levels, and bilirubin levels.Operative time was longer, and the following were more frequent in the drain group: difficult laparoscopic cholecystectomy, gangrene or perforation, empyema, bile spillage, bleeding-control problems, subtotal cholecystectomy, conversion to open surgery, and suspected intraoperative bile leakage.In the multivariable analysis, acute cholecystitis, elevated C-reactive protein levels, difficult laparoscopic cholecystectomy, gangrene or perforation, bile spillage, problems with bleeding control, and subtotal cholecystectomy were independently associated with drain placement.In unadjusted comparisons, patients receiving drains had higher 24-hour pain scores, more frequent requirements for additional analgesia, longer hospital stays, and higher composite 30-day complication rates.Conclusion: Drain placement was predominantly associated with inflammatory severity and operative complexity.The observed postoperative differences cannot be attributed to the drain itself and likely reflect confounding by indication, at least in part.These findings describe the selective use of drains at our institution, but do not establish whether drain placement improves or worsens postoperative outcomes.