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The US government has described drone airstrikes in operations outside declared theaters of armed conflict as surgical and causing minimal civilian casualties. Analysis of air operations in Afghanistan, combined with a review of open-source reports for drone strikes in Pakistan, suggest that these fell short of intended goals. Specifically, drone strikes in Afghanistan were seen to have close to the same number of civilian casualties per incident as manned aircraft, and were an order of magnitude more likely to result in civilian casualties per engagement. Specific causal factors were identified that contributed to the relative propensity of drones to cause civilian casualties. Tailored training that addresses these causal factors could aid in reducing civilian casualties in engagements involving drones. While processes and operating forces in Afghanistan can differ from those in operations outside declared theaters of armed conflict, the factors above suggest that a dedicated analysis of civilian casualties in such operations would be worthwhile.