Xu Fu1,2, Yifei Yang2, Liang Mao2, Yudong Qiu1,2. 1. Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China. 2. Department of Hepatobiliary Pancreatic Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Abstract
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. 2021 Gland Surgery. All rights reserved.
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. 2021 Gland Surgery. All rights reserved.
Authors: O Strobel; S Brangs; U Hinz; T Pausch; F J Hüttner; M K Diener; L Schneider; T Hackert; M W Büchler Journal: Br J Surg Date: 2016-10-20 Impact factor: 6.939
Authors: K Okano; T Hirao; M Unno; T Fujii; H Yoshitomi; S Suzuki; S Satoi; S Takahashi; O Kainuma; Y Suzuki Journal: Br J Surg Date: 2015-09-21 Impact factor: 6.939
Authors: Niels A van der Gaag; Erik A J Rauws; Casper H J van Eijck; Marco J Bruno; Erwin van der Harst; Frank J G M Kubben; Josephus J G M Gerritsen; Jan Willem Greve; Michael F Gerhards; Ignace H J T de Hingh; Jean H Klinkenbijl; Chung Y Nio; Steve M M de Castro; Olivier R C Busch; Thomas M van Gulik; Patrick M M Bossuyt; Dirk J Gouma Journal: N Engl J Med Date: 2010-01-14 Impact factor: 91.245