Dylan Russell1, Freeman Condon2, William Cole2, Sherry Wren3, Christopher Yheulon2. 1. Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96815, USA. dyl.russell@gmail.com. 2. Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96815, USA. 3. Stanford University, Palo Alto Veterans Hospital, Palo Alto, CA, 94304, USA.
Abstract
BACKGROUND: Laparoscopic cholecystectomy is one of the most commonly performed operations in the USA. Surgical site infection complicates 1-2% of these operations and can be associated with significant morbidity. Bile spillage (bile spillage) occurs in many of these operations. The associated risk of surgical site infection (SSI) is an ongoing area of research. METHODS: NSQIP registries between 2005 and 2018 were queried using Current Procedural Terminology codes 47,562 and 47,563 to identify patients undergoing elective laparoscopic cholecystectomy. Patients were considered to have bile spillage if the wound classification was annotated 3 or 4. Acute cholecystitis was excluded by ICD code. Patients were propensity scored for bile spillage and matched for preoperative risk factors. The rates of surgical site infections, morbidity, and mortality and length of stay were analyzed. RESULTS: 47,919 (31,946 with no spillage and 15,973 with spillage) patients were matched and included in the analysis. After matching, no significant difference was found in superficial or deep SSI regardless of bile spillage. An absolute increase in organ-space SSI of 0.32% was detected. The group with bile spillage had small increases in both minor (1.41% vs. 2.12%) and major (0.67% vs. 1.01%) complications. There was no difference in mortality. CONCLUSIONS: This database analysis demonstrates no clinically relevant difference in surgical site infection rates after intraoperative bile spillage.
BACKGROUND: Laparoscopic cholecystectomy is one of the most commonly performed operations in the USA. Surgical site infection complicates 1-2% of these operations and can be associated with significant morbidity. Bile spillage (bile spillage) occurs in many of these operations. The associated risk of surgical site infection (SSI) is an ongoing area of research. METHODS: NSQIP registries between 2005 and 2018 were queried using Current Procedural Terminology codes 47,562 and 47,563 to identify patients undergoing elective laparoscopic cholecystectomy. Patients were considered to have bile spillage if the wound classification was annotated 3 or 4. Acute cholecystitis was excluded by ICD code. Patients were propensity scored for bile spillage and matched for preoperative risk factors. The rates of surgical site infections, morbidity, and mortality and length of stay were analyzed. RESULTS: 47,919 (31,946 with no spillage and 15,973 with spillage) patients were matched and included in the analysis. After matching, no significant difference was found in superficial or deep SSI regardless of bile spillage. An absolute increase in organ-space SSI of 0.32% was detected. The group with bile spillage had small increases in both minor (1.41% vs. 2.12%) and major (0.67% vs. 1.01%) complications. There was no difference in mortality. CONCLUSIONS: This database analysis demonstrates no clinically relevant difference in surgical site infection rates after intraoperative bile spillage.
Authors: Thomas Peponis; Trine G Eskesen; Tomaz Mesar; Noelle Saillant; Haytham M A Kaafarani; D Dante Yeh; Peter J Fagenholz; Marc A de Moya; David R King; George C Velmahos Journal: J Am Coll Surg Date: 2018-03-02 Impact factor: 6.113
Authors: Sora Ely; Kara A Rothenberg; Genna Beattie; Rebecca C Gologorsky; Michelle R Huyser; Ching-Kuo Chang Journal: J Surg Res Date: 2019-10-31 Impact factor: 2.192
Authors: David K Warren; Katelin B Nickel; Anna E Wallace; Daniel Mines; Fang Tian; William J Symons; Victoria J Fraser; Margaret A Olsen Journal: Open Forum Infect Dis Date: 2017-02-22 Impact factor: 3.835
Authors: R N Allan; J S Webb; C J Frapwell; P J Skipp; R P Howlin; E M Angus; Y Hu; A R M Coates Journal: Antimicrob Agents Chemother Date: 2020-04-21 Impact factor: 5.191