Perioperative and anesthetic risk factors of surgical site infection in patients undergoing pancreaticoduodenectomy: A retrospective cohort study

Yamamoto, Saori; Nagamine, Yusuke; Miyashita, Tetsuya; Ito, Shiono; Iwasawa, Yurika; Kawai, Michihiko; Shinsaku, Saito; Tamai, Tomohisa; Goto, Takahisa

doi:10.1371/journal.pone.0240490

Cited by 9 publications

(14 citation statements)

References 33 publications

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“…In this study, the overall incidence of postoperative HAIs from 2013 to 2022 was 8.7%, which was lower than the results in other studies (approximately 17.2-37.8%) [22][23][24] and showed a decreasing trend. The disparity in these findings could be attributed to variations in HAIs prevention and control measures.…”

Section: Discussioncontrasting

confidence: 83%

Epidemiology of healthcare‐associated infections and outcomes among open and robotic pancreatoduodenectomy: A retrospective study from 2013 to 2022

Yu,

Du,

Lin

et al. 2023

J of Gastro and Hepatol

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Background and AimHealthcare‐associated infections (HAIs) after pancreaticoduodenectomy (PD) are one of the common postoperative complications. This study aims to investigate the epidemiology of postoperative HAIs in patients with open pancreaticoduodenectomy (OPD) and robotic pancreaticoduodenectomy (RPD).MethodsThis retrospective cohort study described the trend of HAIs in patients undergoing PD from January 2013 to December 2022 at a tertiary hospital. Patients were divided into OPD and RPD, and the HAIs and outcomes were compared.ResultsAmong 2632 patients who underwent PD, 230 (8.7%, 95% confidence interval [CI] 7.7–9.9%) were diagnosed with HAIs, with a decreasing trend from 2013 to 2022 (P < 0.001 for trend). The incidence of postoperative HAIs was significantly higher in patients with OPD than RPD (9.6% vs 5.8%; P = 0.003). The incidence of HAIs for patients with OPD showed a decreasing trend (P = 0.001 for trend), and the trend for RPD was not significant (P = 0.554 for trend). Logistic regression showed that RPD was significantly associated with postoperative HAIs after adjusting for covariates (adjusted odds ratio = 0.654; 95% CI 0.443–0.965; P = 0.032), especially in the subgroup of patients without preoperative biliary drainage (adjusted odds ratio = 0.486; 95% CI 0.292–0.809; P = 0.006). Regarding clinical outcomes, RPD has a shorter length of stay and a more expensive charge than OPD (all P < 0.05).ConclusionPostoperative HAIs in patients with PD showed a decreasing trend in recent years, especially in OPD. RPD was significantly associated with reduced postoperative HAIs and length of stay, although the charge is more expensive. Attention should be paid to postoperative HAIs in OPD, and it is imperative to continue reducing the costs of RPD.

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Section: Discussioncontrasting

confidence: 83%

Epidemiology of healthcare‐associated infections and outcomes among open and robotic pancreatoduodenectomy: A retrospective study from 2013 to 2022

Yu,

Du,

Lin

et al. 2023

J of Gastro and Hepatol

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“…We had a mean operating time of 391.28 ± 67.86 min and a median blood loss of 705 mL, comparable to those in existing literature [ 5 , 18 , 19 , 27 , 28 ]. Fourteen (33.3%) patients had a Clavien–Dindo grade of III or more, again in conjunction with existing evidence [ 4 ].…”

Section: Discussionsupporting

confidence: 65%

Surgical Site Infections in Patients of Periampullary Carcinoma Undergoing Delayed Bile Duct Division (COMBILAST) in Whipple’s Procedure: A Prospective Cohort Study

et al. 2023

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Surgical site infections (SSIs) following a pancreaticoduodenectomy have been a significant cause of morbidity and even mortality. A modified sequence of the Whipple procedure, using the COMBILAST technique, may reduce SSIs and the patient’s hospital stay. This prospective cohort study included 42 patients undergoing Whipple’s pancreaticoduodenectomy for a periampullary malignancy. The modified sequence pancreaticoduodenectomy technique, COMBILAST, was used to estimate the incidence of SSI and explore other advantages. Of the 42 patients, seven (16.7%) developed superficial SSIs, and two patients (4.8%) had an additional deep SSI. Positive intraoperative bile culture had the strongest association with SSI (OR: 20.25, 95% CI: 2.12, 193.91). The mean operative duration was 391.28 ± 67.86 min, and the mean blood loss was 705 ± 172 mL. A total of fourteen (33.3%) patients had a Clavien–Dindo grade of III or higher. Three (7.1%) patients died of septicemia. The average length of a hospital stay was 13.00 ± 5.92 days. A modified sequence of the Whipple procedure, using the COMBILAST technique, seems promising in reducing SSIs and the patient’s hospital stay. As the approach is only a modification of the operative sequence, it does not compromise the oncological safety of the patient. Moreover, it has an added surgical advantage in reducing the chance of injury to the aberrant or accessory right hepatic artery.

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“…Infectious complications mainly include surgical site infection (SSI), bacteremia, pneumonia and urethra infections. Numerous studies (3,5,(8)(9)(10)(11)(12) have investigated the risk factors of surgical site infection (SSI) after PD, including age, body mass index (BMI), operation time, significant blood loss, blood transfusion and preoperative biliary drainage, etc. However, few studies focus on all the infectious complications.…”

Section: Introductionmentioning

confidence: 99%

Risk factors and microbial spectrum for infectious complications after pancreaticoduodenectomy

Fang¹,

Yang²,

Liang³

et al. 2021

Gland Surg

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Background: Although the mortality of pancreaticoduodenectomy (PD) has decreased, the morbidity especially infections is still a severe challenge. This study aimed to identify the risk factors and microbial spectrum for infectious complications after PD.Methods: This retrospective study of 291 consecutive patients who underwent PD between February 2018 and March 2021 was conducted. The clinical data was reviewed and risk factors associated with infectious complications were analyzed. To investigate the microbial spectrum, microorganisms isolated from preoperative bile, drainage fluid and blood were counted.Results: A total of 110 patients (37.8%) developed postoperative infections. The patients who suffered infections had higher severe complications, prolonged hospitalization and increased expenditures. Three independent risk factors were identified: preoperative biliary drainage (PBD) [odds ratio (OR) 2.082; 95% confidence interval (CI): 1.059-4.091; P=0.033], clinically relevant postoperative pancreatic fistula (CR-POPF) (OR 11.984; 95% CI: 6.556-21.471; P=0.000) and biliary fistula (BF) (OR 3.674; 95% CI: 1.218-11.084; P=0.021). K. pneumoniae and E. faecalis were the most frequently isolated bacteria in preoperative bile and drainage fluid after PD. K. pneumoniae and S. haemolyticus were the most common bacteria in bacteremia patients.Conclusions: PBD, POPF and BF are independent risk factors for infectious complications after PD. To lower the incidence of infection, PBD should be performed only in select cases and efforts should be taken to reduce the POPF and BF. The pathogens of bile and drainage fluid should be monitored throughout the hospital stay.

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Perioperative and anesthetic risk factors of surgical site infection in patients undergoing pancreaticoduodenectomy: A retrospective cohort study

Cited by 9 publications

References 33 publications

Epidemiology of healthcare‐associated infections and outcomes among open and robotic pancreatoduodenectomy: A retrospective study from 2013 to 2022

Epidemiology of healthcare‐associated infections and outcomes among open and robotic pancreatoduodenectomy: A retrospective study from 2013 to 2022

Surgical Site Infections in Patients of Periampullary Carcinoma Undergoing Delayed Bile Duct Division (COMBILAST) in Whipple’s Procedure: A Prospective Cohort Study

Risk factors and microbial spectrum for infectious complications after pancreaticoduodenectomy

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