Background: Despite randomized trials showing no benefit, drain use after open cholecystectomy continues, perhaps as a result of more complicated patient presentation. We examined the reasons for drain use in patients undergoing open cholecystectomy and evaluated the effect of drain placement on surgical outcomes. Methods: Univariate and multivariate analyses compared pre- and intraoperative factors associated with drain placement, and postoperative outcomes in patients undergoing open cholecystectomy at our institution between 2002 and 2007. Results: In 160 patients who underwent open cholecystectomy as primary operative procedure, 92 patients (58%) had a drain placed. In 22% of the cases, the surgeon's stated reason for drain placement was hemorrhage, abscess, non-identification of critical structures, bile spillage, or concern for a bile leak. No reason was provided in78% of the operative reports. Multivariate analysis revealed diagnoses of acute, chronic, or gangrenous cholecystitis (n∈=∈120, 75%), intraoperative bile spillage (n∈=∈60, 38%), and higher than median intraoperative blood loss (>200 ml) as independent predictors of drain use (all p≥0.042). Patients with drains had increased length of hospital stay, postoperative ICU admissions, rates of hospital re-admission, and use of post-operative endoscopy (all p≥0.04). Patients with and without drains had similar rates of postoperative percutaneous drainage, bile leaks, intra-abdominal abscesses, wound infections, and deaths (all p≥0.121). Conclusions: The use of drains after open cholecystectomy was associated with complicated patient presentations: cholecystitis, intraoperative bile spillage, and high intraoperative blood loss. These patients had longer and more complicated postoperative course and more re-admissions. However, use of intraoperative drains was not associated with a reduction in the need for postoperative percutaneous drainage or in improvement in the rates of bile leaks, infections, or deaths. © 2009 Springer-Verlag.