Optimizing Surgical Drain Removal: A Narrative Review of Timing, Criteria, and Evidence-Based Practices

Surgical drains remain a common adjunct in general surgery to prevent fluid collections and detect early postoperative complications. However, their routine use and timing of removal continue to generate debate. This review analyzes evidence-based criteria for drain removal, identifies complications related to prolonged use, and evaluates evolving trends in drain management across gastrointestinal, hepatobiliary, pancreatic, and abdominal wall procedures. The evidence consistently supports early drain removal typically once drainage output is <50 mL/24 h and non-bilious or non-hemorrhagic being associated with lower rates of surgical site infection, fistula formation, and hospital stay duration. Conversely, delayed removal beyond postoperative day five to seven increases the risk of infection, prolonged inflammation, and wound complications. Biochemical monitoring, particularly amylase and bilirubin levels in pancreatic and biliary drains, enables safer, individualized removal decisions. Early, criteria-based, and selective drain management integrated within Enhanced Recovery After Surgery (ERAS) frameworks improves postoperative outcomes and reduces morbidity in general surgery. These findings emphasize the importance of tailored protocols and continued refinement of evidence-driven drain removal practices.