I don't really think of mutable arguments like that as "output parameters". "I/O parameters" maybe. I the sense that C like languages use output parameters where the sole job of the parameter is to return information from the function I don't see a need for output parameters in Perl, although passing references in the parameter list could be used that way.

The run time and memory cost of returning a reference to a large structure, or a list of references to large structures has essentially the same overhead on Perl as passing references back as parameters. Since returning a list of stuff is natural in Perl returning a list of references makes for easier to understand code than working with output parameters.