Background: The optimal type of operative drainage following pancreaticoduodenectomy (PD) remains unclear. Our objective is to investigate risk associated with closed drainage techniques (passive [gravity] vs. suction) after PD.Methods: We assessed operative drainage techniques utilized in patients undergoing PD in the ACS-NSQIP Pancreas-Targeted database from 2016-2018. Using multivariable logistic regression to adjust for characteristics of the patient, procedure, and pancreas, we examined the association between use of gravity drainage and postoperative outcomes.Results: We identified 9,665 patients with drains following PD from 2016-2018, of which 12.7% received gravity drainage. 61.0% had a diagnosis of adenocarcinoma or pancreatitis, 26.5% had a duct <3 mm, and 43.5% had a soft or intermediate gland. After multivariable adjustment, gravity drainage was associated with decreased rates of postoperative pancreatic fistula (odds ratio [OR] 0.804, 95% Confidence Interval [CI] 0.659-0.981, P= 0.031), delayed gastric emptying (OR 0.830, 95%CI 0.693-0.988, P= 0.036), superficial SSI (OR: 0.741, 95% CI: 0.572-0.959, P=0.023), organ space SSI (OR: 0.791, 95% CI: 0.658-0.951, P=0.012), and readmission (OR: 0.807, 95% CI: 0.679-0.958, P=0.014) following PD.Conclusions: Gravity drainage is independently associated with decreased rates of CR-POPF, DGE, SSI, and readmission following PD. Additional prospective research will help determine which method is preferred.