Modern Trends of Drain Placement in Primary Bariatric Surgery: An MBSAQIP Analysis of 526,723 Patients

Prophylactic drain use during primary bariatric surgeries continues despite previous literature cautioning against their routine use. Modern drain utilization and associated outcomes remain largely poorly studied which limits selective utilization and perhaps may lead to excess morbidity and healthcare resource utilization. This study aimed to reassess current trends of drain use in primary bariatric procedures, factors driving surgeons to place drains, and patient outcomes associated with drain placement.

Patients undergoing the most common primary bariatric surgery operations from 2020 to 2022 were included using the Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) database. Two cohorts were created, a drain placed (DP) cohort and no drain (ND) cohort, which were then compared in terms of baseline characteristics, rates of complications, and length of stay. Multivariate modeling was performed to assess the effect of drains on various complications and factors associated with drain placement.

Of 526,723 included patients, drain utilization decreased across operative years (8.7% in 2020 to 6.1% in 2022, p < 0.001). Factors associated with drain placement in multivariate models included older age, higher BMI, partially dependent functional status, renal insufficiency, venous thromboembolism, hypoalbuminemia, and non-sleeve anastomotic procedures. Drain placement was associated with increased risk of numerous complications on bivariate analysis, which was still significant in multivariate analysis, including 30-day serious complications (adjusted odds ratio [aOR] 1.24, p < 0.001), anastomotic leak (aOR 2.1, p < 0.001), organ space infection (aOR 2.0, p < 0.001), reoperation (aOR 1.2, p = 0.036), and excess length of stay (LOS, aOR 1.45, p < 0.001).

The frequency of prophylactic drain placement during primary bariatric surgical procedures has decreased in recent years and patients with drain placement seem to have increased 30-day morbidity, including longer length of stay. Independent predictors of drain placement include increased age and metabolic burden along with anastomotic procedures. Surgeons should be judicious in selecting patients for drain placement and future prospective, controlled studies may better answer drain placement association with complications.