Drain versus no-drain thyroidectomy: a tertiary center experience with a retrospective cohort

The necessity of routine drain placement after thyroidectomy remains a subject of debate. This study aimed to determine whether the use of a drain is necessary irrespective of etiology and whether it prevents early or late postoperative complications. This single-center retrospective cohort study included 144 patients who underwent bilateral total thyroidectomy between January 2020 and June 2025. Patients were divided into no-drain and drain groups. Drain placement was not standardized and was primarily based on surgeon preference, preoperative diagnostic suspicion, and perceived operative complexity. There were no significant differences between the groups regarding age, sex, or length of hospital stay ( p = 0.497). However, drain use was significantly more frequent in patients with malignant etiology ( p < 0.001). No statistically significant differences were observed between the groups regarding early complications, including hematoma, seroma, wound infection, or early postoperative hypoparathyroidism ( p = 0.055). Conversely, late hypoparathyroidism was significantly more frequent in the drain group ( p = 0.001). Postoperative pain levels were significantly higher in the drain group ( p < 0.001), with the mean adjusted 24-hour VAS score being 0.92 points lower in the no-drain group (95% CI: −1.35 to − 0.50). No postoperative cervical hematoma occurred in either group. İn this retrospective, non-randomized cohort, drain placement did not reduce early postoperative complications, and the absence of cervical hematomas limits firm conclusions regarding its preventive role. Furthermore, drain use was associated with increased postoperative pain and a higher rate of late hypoparathyroidism; however, this association is likely confounded by malignancy, operative complexity, and surgeon preference. These findings support the selective omission of drains in routine cases. Future prospective studies with standardized allocation criteria are required to definitively establish any causal relationship.