Objective To evaluate the clinical efficacy and safety of bumetanide in comparison with other diuretics for the prevention and management of postoperative pleural effusion in patients undergoing hepatobiliary surgery. Methods A total of 168 patients undergoing routine hepatobiliary surgery were randomly assigned to either the bumetanide group or the control group （other diuretics）. Patients in the bumetanide group received bumetanide injection at a dose of 1 mg intravenously once daily. In contrast， the control group received one of the following treatments： furosemide injection at 20 mg intravenously once daily， furosemide tablets at 40 mg orally twice daily， or a combination of furosemide tablets （40 mg orally twice daily） and spironolactone tablets （60 mg orally twice daily）. All treatments were administered for three days postoperatively. The incidence of postoperative pleural effusion， length of hospital stay， and drug-related adverse reactions were compared between the two groups. Additionally， multivariate logistic regression analysis was conducted to identify independent risk factors for moderate-to-severe pleural effusion after surgery. Results A total of 82 patients were enrolled in the bumetanide group and 86 in the control group. No significant differences were observed in the general demographic and clinical characteristics between the two groups （P > 0.05）， except for sex and ALT levels （P < 0.05）. The incidence of moderate-to-severe pleural effusion was higher in the control group than in the bumetanide group， with rates of 9.3% and 1.2%， respectively （all P < 0.05）. Additionally， the length of hospital stay was significantly longer in the control group （19.94 ± 0.90 days） compared to the bumetanide group （17.15 ± 1.06 days） （all P < 0.05）. Thoracentesis was performed in 2 cases in the bumetanide group and 8 cases in the control group， but this difference was not statistically significant （P > 0.05）. The primary adverse drug reactions in both groups included hypokalemia， hypochloremia， hyponatremia， and hypocalcemia. The overall incidence of adverse drug reactions was 35.4% in the bumetanide group and 34.9% in the control group， showing no significant difference （P > 0.05）. Multivariate regression analysis revealed that a history of hepatitis B， cirrhosis， and the use of bumetanide were independent predictors of moderate-to-severe pleural effusion during routine hepatobiliary surgery （all P < 0.05）. Conclusions Bumetanide demonstrates superior efficacy compared to other conventional diuretics in the prevention and management of postoperative pleural effusion in hepatobiliary surgery， suggesting potential clinical application value.