Thomas Peponis1, Nikhil Panda2, Trine G Eskesen3, David G Forcione4, Dante D Yeh5, Noelle Saillant6, Haytham M A Kaafarani7, David R King8, Marc A de Moya9, George C Velmahos10, Peter J Fagenholz11. 1. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: tpeponis@mgh.harvard.edu. 2. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: Nikhil.Panda@mgh.harvard.edu. 3. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: trinegeskesen@live.dk. 4. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: dforcione@mgh.harvard.edu. 5. Department of Surgery, University of Miami School of Medicine, Miami, FL, USA. Electronic address: dxy154@med.miami.edu. 6. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: nsaillant@partners.org. 7. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: hkaafarani@partners.org. 8. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: dking3@partners.org. 9. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: mdemoya@mcw.edu. 10. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: gvelmahos@partners.org. 11. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: pfagenholz@partners.org.
Abstract
BACKGROUND: We sought to examine whether preoperative endoscopic retrograde cholangio-pancreatography (ERCP) increases the risk of surgical site infections (SSI) after laparoscopic cholecystectomy. METHODS: Patients admitted to an academic hospital from 2010 to 2016, who were older than 18 and had a laparoscopic or a laparoscopic converted to open cholecystectomy for complicated biliary tract disease were included. We compared those who had a preoperative ERCP to those who did not. Our primary endpoint was the rate of SSI. RESULTS: A total of 640 patients were included. Of them, 122 (19.1%) received preoperative ERCP and 518 (80.9%) did not. The former had different preoperative diagnoses compared to non-ERCP patients (choledocholithiasis [35.2%-7.0%], acute cholecystitis [31.2%-76.4%], gallstone pancreatitis [20.5%-16.2%], and cholangitis [13.1%-0.4%], p < 0.001). The rate of SSI was higher in the preoperative ERCP group (11.5%-4.0%, p = 0.005). In a multivariable analysis conversion to open (OR = 2.57, 95% CI = 1.06-6.21, p = 0.037) and preoperative ERCP (OR = 3.12, 95% CI = 1.34-7.22, p = 0.008) were the only independent predictors of SSI. CONCLUSION: Preoperative ERCP is associated with a threefold increase in the risk of SSI after laparoscopic cholecystectomy.
BACKGROUND: We sought to examine whether preoperative endoscopic retrograde cholangio-pancreatography (ERCP) increases the risk of surgical site infections (SSI) after laparoscopic cholecystectomy. METHODS:Patients admitted to an academic hospital from 2010 to 2016, who were older than 18 and had a laparoscopic or a laparoscopic converted to open cholecystectomy for complicated biliary tract disease were included. We compared those who had a preoperative ERCP to those who did not. Our primary endpoint was the rate of SSI. RESULTS: A total of 640 patients were included. Of them, 122 (19.1%) received preoperative ERCP and 518 (80.9%) did not. The former had different preoperative diagnoses compared to non-ERCP patients (choledocholithiasis [35.2%-7.0%], acute cholecystitis [31.2%-76.4%], gallstone pancreatitis [20.5%-16.2%], and cholangitis [13.1%-0.4%], p < 0.001). The rate of SSI was higher in the preoperative ERCP group (11.5%-4.0%, p = 0.005). In a multivariable analysis conversion to open (OR = 2.57, 95% CI = 1.06-6.21, p = 0.037) and preoperative ERCP (OR = 3.12, 95% CI = 1.34-7.22, p = 0.008) were the only independent predictors of SSI. CONCLUSION: Preoperative ERCP is associated with a threefold increase in the risk of SSI after laparoscopic cholecystectomy.