Scoring System to Predict the Risk of Surgical Site Infection in Patients with Esophageal Cancer after Esophagectomy with Cervical Anastomosis

Yin, Lixia; Chen, Bao-Min; Zhao, Gaofeng; Yuan, Qi-Feng; Xue, Qi; Xu, Ke

doi:10.1089/sur.2018.051

Cited by 11 publications

(12 citation statements)

References 14 publications

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“…It is widely recognized that there are several types of surgical procedures that have accompanying relatively high incidences of SSI in digestive surgery. Patients who undergo thoracic esophagectomy have a higher risk of SSI than those who undergo other types of digestive surgery [ 19 , 20 ]. In the present study, using a propensity-matched cohort, we compared the incidence of SSI after thoracic esophagectomy with olanexidine gluconate or chlorhexidine-alcohol as the antiseptic skin agent.…”

Section: Discussionmentioning

confidence: 99%

Propensity-matched analysis of the efficacy of olanexidine gluconate versus chlorhexidine-alcohol as an antiseptic agent in thoracic esophagectomy

et al. 2022

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Background In the present matched-cohort study, we investigated the efficacy of olanexidine gluconate in comparison with chlorhexidine-alcohol as an antiseptic agent in thoracic esophagectomy. Methods A total of 372 patients with esophageal cancer who were scheduled to undergo thoracic esophagectomy between 2016 and 2018 were assigned to one of two groups based on the preoperative antiseptic agent used in thoracic esophagectomy. We investigated the incidence of surgical site infectious complications in the propensity-matched cohort. Results Based on the propensity score, 116 patients prepared with 1.5% olanexidine gluconate and 114 patients prepared with 1.0% chlorhexidine-alcohol as surgical skin antisepsis were selected. No significant intergroup differences were observed with respect to incisional surgical site infection (0.8% in the olanexidine group versus 0.8% in the chlorhexidine group) and deep fascial/organ space surgical site infection (1.7%/10.3% in the olanexidine group versus 3.5%/15.7% in the chlorhexidine group, p = 0.39/p = 0.03). Notably, the respective incidences of surgical site infection except anastomotic leakage were 1.7% and 7.0% in the olanexidine and chlorhexidine groups (p = 0.04). Conclusions Olanexidine gluconate was well tolerated and significantly reduced incidence of surgical site infection except anastomotic leakage in comparison with chlorhexidine-alcohol as an antiseptic agent in thoracic esophagectomy with three-field lymph node dissection.

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Section: Discussionmentioning

confidence: 99%

Propensity-matched analysis of the efficacy of olanexidine gluconate versus chlorhexidine-alcohol as an antiseptic agent in thoracic esophagectomy

et al. 2022

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“…In patients with intra-abdominal infections, host-related factors dominate over the type, extent, and source of infection in determining prognosis, and low serum albumin is one of few identified risk factors for mortality [ 167 ]. Preoperative or perioperative hypoalbuminemia is an independent risk factor for the development of surgical site infection in patients undergoing gastrointestinal surgery [ 168 , 169 , 170 , 171 , 172 , 173 ]. Inclusion of preoperative serum albumin levels enabled development of a validated stratification scoring system to predict accurately the risk of surgical site infection after esophagectomy in patients with esophagus carcinoma [ 173 ].…”

Section: Hypoalbuminemia and Prognosis In Infectionsmentioning

confidence: 99%

“…Preoperative or perioperative hypoalbuminemia is an independent risk factor for the development of surgical site infection in patients undergoing gastrointestinal surgery [ 168 , 169 , 170 , 171 , 172 , 173 ]. Inclusion of preoperative serum albumin levels enabled development of a validated stratification scoring system to predict accurately the risk of surgical site infection after esophagectomy in patients with esophagus carcinoma [ 173 ]. Patients with hypoalbuminemia are at increased risk of developing surgical site infections after gastric [ 170 ] and colorectal [ 172 ] cancer surgery.…”

Section: Hypoalbuminemia and Prognosis In Infectionsmentioning

confidence: 99%

Hypoalbuminemia as Surrogate and Culprit of Infections

Wiedermann¹

2021

IJMS

140

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Hypoalbuminemia is associated with the acquisition and severity of infectious diseases, and intact innate and adaptive immune responses depend on albumin. Albumin oxidation and breakdown affect interactions with bioactive lipid mediators that play important roles in antimicrobial defense and repair. There is bio-mechanistic plausibility for a causal link between hypoalbuminemia and increased risks of primary and secondary infections. Serum albumin levels have prognostic value for complications in viral, bacterial and fungal infections, and for infectious complications of non-infective chronic conditions. Hypoalbuminemia predicts the development of healthcare-associated infections, particularly with Clostridium difficile. In coronavirus disease 2019, hypoalbuminemia correlates with viral load and degree of acute lung injury and organ dysfunction. Non-oncotic properties of albumin affect the pharmacokinetics and pharmacodynamics of antimicrobials. Low serum albumin is associated with inadequate antimicrobial treatment. Infusion of human albumin solution (HAS) supplements endogenous albumin in patients with cirrhosis of the liver and effectively supported antimicrobial therapy in randomized controlled trials (RCTs). Evidence of the beneficial effects of HAS on infections in hypoalbuminemic patients without cirrhosis is largely observational. Prospective RCTs are underway and, if hypotheses are confirmed, could lead to changes in clinical practice for the management of hypoalbuminemic patients with infections or at risk of infectious complications.

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“…Besides, as gastric conduit is widely applied, most esophageal anastomotic leak, small and latent with varied clinical symptoms in early stages, could be likely to result in abscess cavity or even systematic infection when be found out [7]. Thus, even the anastomosis is close to the cervical incision in McKeown esophagectomy, the signs of leak are not always obvious enough for early recognition and management, resulting in serious infection in neck, mediastinum and even chest [8, 9]. We have collected preoperative variables to identify which are risk factors for anastomotic leak.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of preoperative risk factors and postoperative indicators for anastomotic leak of minimally invasive McKeown esophagectomy: a single-center retrospective analysis

Gao

Xú

Wang

et al. 2019

J Cardiothorac Surg

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Background Minimally invasive McKeown esophagectomy is an important surgical approach for esophageal cancer. Anastomotic leak is one of its common and serious complications. We assumed that the preoperative risk factors and postoperative indicators would predict or detect anastomotic leak. Methods Between December 2016 and July 2017, patients underwent minimally invasive McKeown esophagectomy were identified and their preoperative variables and postoperative test indicators were recorded. Fisher’s exact test, 2-tailed unpaired t test, nonparametric test and logistic regression were used to compare these datum between patients with or without anastomotic leak (AL). Receiver Operator Characteristic (ROC) curve was used to identify the best cut-off value of drainage amylase concentration for distinguishing anastomotic leak. Results In all the 96 patients included, 12 patients were diagnosed as anastomotic leak by the esophagram. No differences in preoperative variables were observed between patients with and without AL. Patients in AL group appeared to have a lower prealbumin concentration in AL group on POD (postoperative day) 4( P = 0.05), POD 5( P = 0.04), POD 6 ( P = 0.06). Prealbumin concentration cutoff value of 128 g/L on postoperative day 5 is 100.00% sensitive and 50.00% specific for predicting esophageal leaks. Drain amylases levels were higher in patients with anastomotic leak than those without anastomotic leak on POD 3( P = 0.03), POD 4( P = 0.01), POD 5( P < 0.001), POD 6( P < 0.001). The drain amylase cutoff value of 85 IU/L on postoperative day 4 was 75.00% sensitive and 84.00% specific for detecting esophageal leaks; the cutoff value of 65 IU/L on postoperative day 5 was 91.67% sensitive and 80.77% specific. The cutoff of 55/L on POD 6 is 100% sensitive and 86.96% specific. Conclusion Drainage amylase concentration on postoperative days may help to discover anastomotic leak in early stage after minimally invasive McKeown esophagectomy. Prealbumin concentration below 128 g/L on POD 5 might be potential risk factor for anastomotic leak.

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Scoring System to Predict the Risk of Surgical Site Infection in Patients with Esophageal Cancer after Esophagectomy with Cervical Anastomosis

Abstract: The validated stratification scoring system could predict accurately the risk of SSI after esophagectomy with cervical anastomosis. This could be helpful in the selection of high-risk patients requiring frequent monitoring and more aggressive interventions to decrease the incidence of SSI.

Cited by 11 publications

References 14 publications

Propensity-matched analysis of the efficacy of olanexidine gluconate versus chlorhexidine-alcohol as an antiseptic agent in thoracic esophagectomy

Propensity-matched analysis of the efficacy of olanexidine gluconate versus chlorhexidine-alcohol as an antiseptic agent in thoracic esophagectomy

Hypoalbuminemia as Surrogate and Culprit of Infections

Evaluation of preoperative risk factors and postoperative indicators for anastomotic leak of minimally invasive McKeown esophagectomy: a single-center retrospective analysis

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