Risk factors for organ/space surgical site infection after hepatectomy for hepatocellular carcinoma in 359 recent cases

Shinmoto, Hiroshi; Yagi, T.; Shinoura, Susumu; Umeda, Yuzo; Yoshida, Ryuichi; Satoh, Daisuke; Nobuoka, Daisuke; Utsumi, Masashi; Yoshida, Kazuhiro; Fujiwara, Toshiyoshi

doi:10.1007/s00534-011-0503-5

Cited by 37 publications

(31 citation statements)

References 35 publications

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“…In other studies, reoperation was also found to be a negative factor related to SSIs. Sadamori et al [31] demonstrated that repeat hepatectomy was an independent risk factor for bile leakage and organ/space SSIs after hepatectomy in hepatocellular carcinoma recurrence. Postoperative infections including SSIs also remain a significant problem among liver transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

A nomogram prediction of postoperative surgical site infections in patients with perihilar cholangiocarcinoma

Ding

Han³

et al. 2017

Medicine

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Surgical site infection (SSI) is one of the major morbidities after radical resection for perihilar cholangiocarcinoma (PHCC). This study aimed to clarify the risk factors and construct a nomogram to predict SSIs in patients with PHCC.A total of 335 consecutive patients who underwent hepatectomy combined with hepaticojejunostomy between January 2013 and December 2015 were analyzed retrospectively. SSIs, including incisional (superficial and deep) and space/organ infection, were defined according to the Centers for Disease Control and Prevention (CDC)'s National Nosocomial Infection Surveillance (NNIS) system. Risk factors associated with postoperative SSIs were analyzed by univariate and multivariate analyses. A nomogram was developed on the basis of results from the multivariate logistic model and the discriminatory ability of the model was analyzed.PHCC patients had higher organ/space SSI rate than incisional SSI rate after radical resection. Multivariate analysis showed that risk factors indicating postoperative overall SSIs (incisional and organ/space) included coexisting cholangiolithiasis [odds ratio (OR): 6.77; 95% confidence interval (95% CI): 2.40–19.11; P < .001], blood loss >1500 mL (OR: 4.77; 95% CI: 1.45–15.65; P = .010), having abdominal surgical history (OR: 5.85; 95% CI: 1.91–17.97; P = .002), and bile leakage (OR: 15.28; 95% CI: 5.90–39.62; P < .001). The β coefficients from the multivariate logistic model were used to construct the model for estimation of SSI risk. The scoring model was as follows: −4.12 +1.91 × (coexisting cholangiolithiasis = 1) + 1.77 × (having previous abdominal surgical history = 1) +1.56 × (blood loss >1500 mL = 1) + 2.73 × (bile leakage = 1). The discriminatory ability of the model was good and the area under the receiver operating characteristic (ROC) curve (AUC) was 0.851.In PHCC patients, there may be a relationship between postoperative SSIs and abdominal surgical history, coexisting cholangiolithiasis, bile leakage, and blood loss. The nomogram can be used to estimate the risk of postoperative SSIs in patients with PHCC.

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Section: Discussionmentioning

confidence: 99%

A nomogram prediction of postoperative surgical site infections in patients with perihilar cholangiocarcinoma

Ding

Han³

et al. 2017

Medicine

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“…Surgical procedures (Table 1), operative time, intraoperative blood loss, and blood transfusion were recorded as intraoperative outcomes. Details of the surgical techniques of hepatectomy, pancreaticoduodenectomy, and hepatopancreatectomy have been reported previously [11][12][13][14]. At our center, age is not recognized as a contraindication.…”

Section: Clinical Datamentioning

confidence: 99%

The Outcome of Complex Hepato-Pancreato-Biliary Surgery for Elderly Patients: A Propensity Score Matching Analysis

et al. 2018

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Background/Aims: Postoperative mortality and morbidity rates after hepato-pancreato-biliary (HPB) surgery remain high, and the number of elderly patients requiring such surgery has been increasing. This study aimed to investigate postoperative outcomes of complex HPB surgery for elderly patients. Methods: We retrospectively reviewed perioperative data of 721 patients who underwent complex HPB surgery between 2010 and 2015. The patients were divided into 2 groups: elderly (≥75 years) and non-elderly (< 75 years). Surgical outcomes of both groups were compared after propensity score-matching analysis. Subsequently, risk factors for serious postoperative morbidity were identified by multivariate analysis. Results: Before matching, the elderly group (n = 170) had more comorbidities, such as cardiovascular and renal disease, than the non-elderly group (n = 551). Matching yielded elderly (n = 170) and non-elderly groups (n = 170) with similar preoperative backgrounds. The mortality and morbidity rates did not differ significantly between the groups. In multivariate analyses, operative time (OR 1.79; p = 0.005) and blood loss (OR 1.66; p = 0.03) were identified as independent risk factors for serious postoperative morbidity, whereas older age did not have a predictive impact (OR 1.16; p = 0.52). Conclusions: Although elderly patients had more comorbidities and higher incidences of postoperative mortality and several complications before matching, their postoperative outcomes were equivalent to those of non-elderly patients after matching.

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“…Details of the surgical techniques have been reported previously [8]. Concerning tumor characteristics, the pathological findings were evaluated in accordance with the rules of the Liver Cancer Study Group of Japan [9].…”

Section: Clinical Datamentioning

confidence: 99%

Preoperative Controlling Nutritional Status Score Predicts Mortality after Hepatectomy for Hepatocellular Carcinoma

et al. 2018

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Background: Preoperative nutritional status is reportedly associated with postoperative outcomes in patients with hepatocellular carcinoma. This study aimed to investigate the significance of the controlling nutritional status (CONUT) score and the prognostic nutritional index (PNI) as predictors of postoperative outcomes. Methods: We retrospectively reviewed data from 331 patients who underwent hepatectomy for hepatocellular carcinoma between January 2007 and December 2015. Patients were divided into 2 groups based on their CONUT score and the PNI. We evaluated the effect of the CONUT score and PNI on perioperative outcomes. Multivariate analysis was performed to identify independent predictors of in-hospital mortality after hepatectomy. Results: The high CONUT group had a significantly higher incidence of 30-day mortality (p < 0.001), in-hospital mortality (p = 0.002), ascites (p = 0.006), liver failure (p = 0.02), sepsis (p = 0.01), and enteritis (p < 0.001). The low PNI group was also significantly associated with 30-day mortality (p < 0.001), in-hospital mortality (p = 0.003), liver failure (p < 0.001), sepsis (p = 0.02), enteritis (p = 0.02), and hospital stay (p = 0.01). In multivariate analyses, a high CONUT score was an independent predictor of in-hospital mortality after hepatectomy (hazard ratio [HR] 9.41, p = 0.038), but the PNI was not (HR 5.86, p = 0.08). Conclusions: Preoperative assessment of the CONUT score is helpful for evaluating patients’ nutritional status and mortality risk after liver surgery.

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Risk factors for organ/space surgical site infection after hepatectomy for hepatocellular carcinoma in 359 recent cases

Abstract: Repeat hepatectomy and bile leakage represent independent risk factors for organ/space SSIs after hepatectomy for HCC. Establishing treatment strategies is important for preventing postoperative bile leakage and reducing the high rate of organ/space SSIs after repeat hepatectomy.

Cited by 37 publications

References 35 publications

A nomogram prediction of postoperative surgical site infections in patients with perihilar cholangiocarcinoma

A nomogram prediction of postoperative surgical site infections in patients with perihilar cholangiocarcinoma

The Outcome of Complex Hepato-Pancreato-Biliary Surgery for Elderly Patients: A Propensity Score Matching Analysis

Preoperative Controlling Nutritional Status Score Predicts Mortality after Hepatectomy for Hepatocellular Carcinoma

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