Impact of abdominal drainage time and bed rest duration on postoperative recovery in patients undergoing laparoscopic appendectomy: a single-center retrospective study

The optimal duration of abdominal drainage and bed rest after laparoscopic appendectomy (LA) remains uncertain. This study investigated whether these modifiable factors are associated with residual intra-abdominal infection (RII) and prolonged length of hospital stay (LOS). To retrospectively analyze the risk factors for RII and prolonged LOS following LA and clarify the impact of abdominal drainage time and bed rest duration on postoperative recovery. This retrospective study included 478 adults who underwent LA for acute appendicitis (2017-2020). Patients were followed weekly for 4 weeks. RII was defined as a composite endpoint occurring between postoperative day 5 and 4 weeks. Multivariable logistic regression identified factors associated with RII and prolonged LOS (≥5 days). Subgroup analyses were exploratory due to small sample sizes. RII occurred in 59 patients (12.3%). In the overall cohort, independent factors for RII were complicated appendicitis (OR 4.35), drainage ≥36 h (OR 3.69), bed rest ≥24 h (OR 3.27), and Neutrophil-to-lymphocyte ratio (NLR) ≥6.64 (OR 3.18) (all P <0.05). Drainage <36 h was not associated with increased risk. Exploratory subgroup analyses suggested drainage ≥36 h as the only factor for RII in uncomplicated appendicitis (OR 7.47), while bed rest ≥24 h (OR 7.21), elevated White blood cell count (WBC) (OR 4.65), and NLR (OR 6.02) were associated in complicated appendicitis. For prolonged LOS (198 events), independent factors were surgical complications (OR 6.14) and drainage ≥36 h (OR 4.74). Exploratory subgroup analyses showed surgical complications and drainage ≥36 h were significant in uncomplicated appendicitis, while only surgical complications remained in complicated appendicitis. Prolonged drainage (≥36 h) and bed rest (≥24 h) were associated with increased RII in the overall cohort; however, sensitivity analysis revealed variability in effect estimates, underscoring the need for cautious interpretation. Subgroup findings are exploratory and require confirmation. Prolonged drainage and surgical complications were associated with longer LOS. Drainage <36 h appeared safe. These findings suggest potential benefits of avoiding routine drainage, early drain removal, and early mobilization, but require confirmation in larger prospective studies.