Disparities in the management and prophylaxis of surgical site infection and pancreatic fistula after pancreatoduodenectomy

Abstract

Our survey demonstrated significant heterogeneity in perioperative management between HPB surgeons across different regions worldwide. Further studies are warranted to assess the impact of these variations on outcomes of patients undergoing PD. Efforts should be directed towards standardization of perioperative management of PD.

Risk factors for surgical site infection after pancreatic surgery: a better postoperative antibiotic strategy is possible

“…The median age was 68 [60-77] years. The median SOFA score at admission was 2 [2][3][4][5] and the median SAPS II was 23 [18][19][20][21][22][23][24][25][26][27][28][29][30]. PD and DPS patients had similar characteristics.…”

“…The high incidence of postoperative complications after pancreatic surgery [1,2] has led many teams to routinely prescribe postoperative antibiotics after pancreaticoduodenectomy (PD) [3,4]. This approach is not universal; some authors suggest that prophylactic antibiotic prescription can be limited to the first 24 hours postoperatively [5], while others recommend routine longer term use of antibiotics, especially in high-risk patients [3], or when surgery is preceded by preoperative biliary drainage [4]. Indeed, preoperative bile duct drainage is associated with increased infectious morbidity and a higher mortality rate in PD [6,7].…”

Successful Treatment of Pancreatic Fistula Following Surgery for Congenital Biliary Dilatation with Endoscopic Ultrasound-Guided Transduodenal Drainage

“…PF remains one of the most notable clinical complications that are directly linked to surgery-related death. Regarding the treatment of PF, antibacterial drugs [ 10 ], nutritional support [ 11 ], somatostatin analogs [ 12 , 13 ], interventional radiology [ 14 , 15 ], and surgical treatment [ 16 , 17 ], among others, were mentioned. Although the standard treatment has not yet been established, there seems to be no dispute that drainage is the most important.…”

Perioperative Broad-spectrum Antibiotics are Associated With Decreased Surgical Site Infections Compared to 1st–3rd Generation Cephalosporins After Open Pancreaticoduodenectomy in Patients With Jaundice or a Biliary Stent

“…The evidence supporting the biliary microbiome as a major source of SSI after PD have led some to advocate for antibiotic selection based on preoperative biliary cultures 40 . However, according to a survey by Macedo et al, 38% of 108 North American surgeons will not obtain preoperative bile cultures in patients undergoing endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography, and this number may be an underestimation 16 . Furthermore, not all patients with cholestasis will undergo preoperative percutaneous transhepatic cholangiography or endoscopic retrograde cholangiopancreatography, as these procedures are not always indicated, may result in additional complications, and may delay time to treatment.…”

“…The definition of Broad-abx included multiple agents, including piperacillin-tazobac-tam, thus the ability to identify a specific agent within this class was limited. Duration and adequate timing of prophylactic antibiotic use in pancreatic surgery was not available in this dataset, however, it is estimated that 70% of surgeons in North America terminate prophylactic antibiotics within 24 hours of surgery 16 . The use of institutional culture surveillance, institutional antibiograms, and preoperative/ intraoperative bile culture were also not available in this dataset.…”