A total of 1005 patients underwent major hepatectomy; 500 patients (49.8 %) had prophylactic drains placed at the conclusion of the procedure. Drain placement was associated with any complication (
p < 0.001), blood transfusion (
p < 0.001), renal insufficiency (
p = 0.02), bile leak (
p < 0.001), invasive intervention (
p = 0.02), length of stay (
p = 0.001), and readmission (
p < 0.001). In the matched cohort, drain placement was associated with any complication (
p < 0.001), blood transfusion (
p < 0.001), superficial surgical site infection (SSI) (
p = 0.028), bile leak (
p < 0.001), and longer length of stay (0.03). In addition, placement of a prophylactic drain did not decrease the rate of postoperative bile leaks requiring therapeutic intervention (
p = 0.21) (Table
2). In multivariate analysis, drain placement was independently associated with any complication (
p < 0.001), blood transfusion (
p = 0.02), bile leak (
p < 0.001), invasive intervention (
p = 0.011), superficial surgical site infection (SSI) (
p = 0.039), and hospital readmission (
p = 0.005) (Table
3). Placement of a prophylactic drain did not decrease the rate of postoperative bile leaks requiring therapeutic intervention (
p = 0.15).