Intraoperative pelvic drain placement and postoperative outcomes following robot-assisted radical cystectomy: a...

Pelvic drains have traditionally been utilized following radical cystectomy to facilitate early identification of urinary leaks and postoperative complications. However, evidence supporting routine drain placement following robot-assisted radical cystectomy (RARC) remains limited. This study evaluated the association between intraoperative pelvic drain placement and postoperative outcomes following RARC. Patients undergoing RARC were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified according to intraoperative pelvic drain placement. Baseline characteristics, perioperative variables, and 30-day postoperative outcomes were compared between cohorts. Multivariable logistic and linear regression analyses adjusting for demographic characteristics, comorbidities, American Society of Anesthesiologists classification, and operative time were performed. A total of 5,256 patients undergoing RARC were identified, including 4,946 (94.1%) managed with pelvic drains and 310 (5.9%) without drains. Drain placement was associated with longer operative duration (363.3 ± 124.8 vs. 294.6 ± 117.6 min, p < 0.001), while no significant difference hospital length of stay was found between cohorts (p = 0.294). On unadjusted analysis, urinary tract infection was more common in patients managed without drains (9.4% vs. 5.2%, p = 0.002), whereas ureteral obstruction was more frequent in the drain cohort (5.6% vs. 2.3%, p = 0.012). Rates of mortality, readmission, reoperation, overall complications, urinary leak, sepsis, and surgical site infection were otherwise similar between groups. Following multivariable adjustment, drain placement was independently associated with lower odds of urinary tract infection (adjusted odds ratio [aOR] 0.55, 95% confidence interval [CI] 0.37-0.84, p = 0.005) and higher odds of ureteral obstruction (aOR 2.85, 95% CI 1.31-6.19, p = 0.009), without significant associations with most other major postoperative outcomes. Routine pelvic drain placement following RARC was not independently associated with reductions in most major postoperative complications. These findings suggest that routine prophylactic drain utilization may provide limited overall benefit following contemporary robotic cystectomy and support a more individualized approach to drain placement.