Background: Adverse events (AEs) after hepatectomy (Hx) have decreased. The aim of this study was to assess the safety of Hx and to identify the risks and benefits of drain insertion. Methods: From 2010 to 2012, a multicenter, prospective cohort study was conducted in consecutive patients who underwent Hx. Patients who were scheduled to undergo Hx with neither reconstruction of the biliary tract nor concomitant resection of other organs were excluded. AEs were graded based on the Clavien–Dindo classification. Univariate analysis was performed to identify the risks and benefits in all cases and in selected cases matched by propensity score. Results: This study included 197 patients. AEs occurred in 20 (10.1%). In all cases, no difference in the rate of AE was observed between those with and without drain insertion. Postoperative hospital stay in the group with drains (n = 132) was statistically longer than that in the group without drains (n = 65) (17.7 vs. 11.5 days, P = 0.001). In patients without AE (n = 177), hospital stay in the group with drains was statistically longer than that in the group without drains (14.1 vs. 11.3 days, P < 0.001). In propensity score-matched cases (41 cases in each group), postoperative hospital stay in the group with drains was also statistically longer than that in the group without drains (17.3 vs. 11.4 days, P = 0.003). Conclusion: Drain insertion after hepatectomy may lead to longer hospital stay in patients with and without AE.
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