Percutaneous biliary interventions are becoming increasingly available and complex. However, little data exists on the type and prevalence of complications after patients are discharged. A retrospective review of all adult patients who underwent initial percutaneous biliary drain (PBD) placement between January 1, 2016, and December 1, 2018, was performed with patient follow-up through May 15, 2020. Patients discharged with a PBD were then identified; those who were discharged to hospice or with documented plans for outside follow up were excluded. All patients underwent drain exchange during each cholangiogram per local practice pattern. An outpatient indication for cholangiogram was defined as direct admission from the emergency department or outside hospital with cholangiogram performed within 72 hours of initial admission or patients who presented directly to interventional radiology for PBD interrogation. Indications were standardized into 13 unique categories based on previously described complications of biliary interventional procedures; combination indications were coded into the most clinically severe complication. 157 patients met inclusion criteria. There were 402 cholangiograms in 111 patients with outpatient indications. 267 (66.4%) cholangiograms were unplanned. 89 of 157 (56.6%) patients discharged with a PBD experienced at least one unplanned exchange; indications are presented in the Table. Factors associated with increased number of percutaneous biliary drain exchanges were evaluated. There was no difference in benign or malignant etiology (1.6 vs 1.7, P = 0.881) or initial indication of obstruction or leak (1.9 vs 1.1, P = 0.093). Women had a significantly higher number of unplanned exchanges (3.1 vs 1.1, P = 0.001). When patients with underlying malignancy were isolated, patients with cholangiocarcinoma had more unplanned outpatient exchanges than those with other malignancies leading to PBD placement (2.1 vs 1.1, P = 0.01). Outpatient complications in patients discharged with percutaneous biliary drains requiring repeat cholangiogram are common, with over half of patients experiencing at least one unplanned exchange. Women and patients with cholangiocarcinoma appear to be at increased risk of these events.Tabled 1ComplicationPatients (of 157 total)PercentTube dislodgement4629.3%Fever or cholangitis3622.9%Bleeding85.1%Tube clogging95.7%Hyperbilirubinemia159.6%Tube leak, irritation, or pain requiring exchange2817.8% Open table in a new tab