Distinction of Risk Factors for Superficial vs Organ-Space Surgical Site Infections After Pancreatic Surgery

Elliott, Irmina A.; Chan, Carmen K. M.; Russell, Tara A.; Dann, Amanda M.; Williams, Jennifer L.; Damato, Lauren; Chung, Hyun-Kyung; Girgis, Mark D.; Hines, Oscar J.; Reber, Howard A.; Donahue, Timothy R.

doi:10.1001/jamasurg.2017.2155

Cited by 38 publications

(55 citation statements)

References 17 publications

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“…We also acknowledge the stringent nature of the eligibility criteria and its limits on the trial's generalizability to a higher-risk patient cohort. Discharge by POD 5 after PD is radically below the national median, 40 and these criteria were conceived to ensure safety. These data appear applicable to high-performing PD patients at low risk of complications and suggest that if these patients are recovering well from operations, hospitalization beyond POD 5 is unnecessary.…”

Section: Discussionmentioning

confidence: 99%

Enhancing Patient Outcomes while Containing Costs after Complex Abdominal Operation: A Randomized Controlled Trial of the Whipple Accelerated Recovery Pathway

Lavu

McCall

Winter

et al. 2019

Journal of the American College of Surgeons

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BACKGROUND: This study was designed to determine whether a standardized recovery pathway could reduce post-pancreaticoduodenectomy hospital length of stay to 5 days without increasing complication or readmission rates. STUDY DESIGN: Pancreaticoduodenectomy patients (high-risk patients excluded) were enrolled in an IRBapproved, prospective, randomized controlled trial (NCT02517268) comparing a 5-day Whipple accelerated recovery pathway (WARP) with our traditional 7-day pathway (control). Whipple accelerated recovery pathway interventions included early discharge planning, shortened ICU stay, modified postoperative dietary and drain management algorithm, rigorous physical therapy with in-hospital gym visit, standardized rectal suppository administration, and close telehealth follow-up post discharge. The trial was powered to detect an increase in postoperative day 5 discharge from 10% to 30% (80% power, a ¼ 0.05, 2sided Fisher's exact test, target accrual: 142 patients). RESULTS: Seventy-six patients (37 WARP, 39 control) were randomized from June 2015 to September 2017. A planned interim analysis was conducted at 50% trial accrual resulting in mandatory early stoppage, as the predefined efficacy end point was met. Demographic variables between groups were similar. The WARP significantly increased the number of patients discharged to home by postoperative day 5 compared with controls (75.7% vs 12.8%; p < 0.001) without increasing readmission rates (8.1% vs 10.3%; p ¼ 1.0). Overall complication rates did not differ between groups (29.7% vs 43.6%; p ¼ 0.24), but the WARP significantly reduced the time from operation to adjuvant therapy initiation (51 days vs 66 days; p ¼ 0.005) and hospital cost ($26,563 vs $31,845; p ¼ 0.011). CONCLUSIONS: The WARP can safely reduce hospital length of stay, time to adjuvant therapy, and cost in selected pancreaticoduodenectomy patients without increasing readmission risk.

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Section: Discussionmentioning

confidence: 99%

Enhancing Patient Outcomes while Containing Costs after Complex Abdominal Operation: A Randomized Controlled Trial of the Whipple Accelerated Recovery Pathway

Lavu

McCall

Winter

et al. 2019

Journal of the American College of Surgeons

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“…Surgical site infection of Japan Clinical Oncology Group postoperative complications criteria grade 2 or higher was defined as the primary outcome, which was characterized by infection of the incision or intra-abdominal space requiring pharmacological or surgical treatments [22]. We also investigated the incidence of postoperative pancreatic fistula, a postoperative complication associated with space surgical site infections in pancreatic surgery [13,24]. A postoperative pancreatic fistula was defined according to the International Study Group on Pancreatic Fistula guidelines [25].…”

Section: Outcomementioning

confidence: 99%

Perioperative and anesthetic risk factors of surgical site infection in patients undergoing pancreaticoduodenectomy: A retrospective cohort study

et al. 2020

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Background Surgical site infection is a major perioperative issue. The morbidity of surgical site infection is high in major digestive surgery, such as pancreaticoduodenectomy. The comprehensive risk factors, including anesthetic factors, for surgical site infection in pancreaticoduodenectomy are unknown. The aim of this study was to investigate the perioperative and anesthetic risk factors of surgical site infection in pancreaticoduodenectomy. Methods This was a retrospective cohort study conducted in a single tertiary care center. A total of 326 consecutive patients who underwent pancreaticoduodenectomy between January 2009 and March 2018 were evaluated. Patients who underwent resection of other organs were excluded. The primary outcome was the incidence of surgical site infection, based on a Clavien-Dindo classification of grade 2 or higher. Multivariable logistic regression analysis was performed to investigate the association between surgical site infection and perioperative and anesthetic factors. Results Of the 326 patients, 116 (35.6%) were women. The median age was 70 years (interquartile range; 64-75). The median duration of surgery was 10.9 hours (interquartile range; 9.5-12.4). Surgical site infection occurred in 60 patients (18.4%). The multivariable analysis revealed that the use of desflurane as a maintenance anesthetic was associated with a significantly lower risk of surgical site infection than sevoflurane (odds ratio, 0.503; 95% confidence interval [CI], 0.260-0.973). In contrast, the duration of surgery (odds ratio, 1.162; 95% CI, 1.017-1.328), cerebrovascular disease (odds ratio, 3.544; 95% CI, 1.326-9.469), and ischemic heart disease (odds ratio, 10.839; 95% CI, 1.887-62.249) were identified as significant risk factors of surgical site infection.

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“…Surgical site infections (SSI) were classified in a simplified manner as [ 8 , 9 ] parietal abscesses or intra-abdominal collection. A respiratory infection was defined as a fever associated with a biological inflammatory syndrome and imaging suggestive of bronchopulmonary infection.…”

Section: Methodsmentioning

confidence: 99%

“…They will also have oncological impact, delaying the start of adjuvant treatment and doubling the risk of not receiving it [ 5 , 6 , 7 ]. There are two types of infectious complications, surgical site infections (SSI), as defined by the Center for Disease Control [ 8 , 9 ], and general infectious complications, such as urinary, respiratory, and vascular access infections. SSI occur in 10 to 30% of cases after PD [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…There are two types of infectious complications, surgical site infections (SSI), as defined by the Center for Disease Control [ 8 , 9 ], and general infectious complications, such as urinary, respiratory, and vascular access infections. SSI occur in 10 to 30% of cases after PD [ 9 , 10 ]. The risk factors for the occurrence of an SSI after PD are: male gender and age >70 years old [ 11 , 12 ]; the presence of postoperative pancreatic fistula (PF) is one of the factors most strongly associated with the occurrence of deep intra-abdominal infection (odds ratios (OR) = 7.6; 95% CI = 4.35–13.14; p < 0.001) [ 10 ], a long operating time (OR = 3.22; 95% CI = 1.82–5.69; p < 0,001) [ 10 ], significant blood loss, and the need for blood transfusion [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Does Fungal Biliary Contamination after Preoperative Biliary Drainage Increase Postoperative Complications after Pancreaticoduodenectomy?

Tortajada

Sauvanet

Truant

et al. 2020

Cancers

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(1) Background: preoperative biliary drainage before pancreaticoduodenectomy (PD) is associated with bacterial biliary contamination (>85%) and a significant increase in global and infectious complications. In view of the lack of published data, the aim of our study was to investigate the impact of fungal biliary contamination after biliary drainage on the complication rate after PD. (2) Methods: a multicentric retrospective study that included 224 patients who underwent PD after biliary drainage with intraoperative biliary culture. (3) Results: the global rate of positive intraoperative biliary sample was 92%. Respectively, the global rate of biliary bacterial contamination and the rate of fungal contamination were 75% and 25%, making it possible to identify two subgroups: bacterial contamination only (B+, n = 154), and bacterial and fungal contamination (BF+, n = 52). An extended duration of preoperative drainage (62 vs. 49 days; p = 0.08) increased the risk of fungal contamination. The overall and infectious complication rates were not different between the two groups. In the event of postoperative infectious or surgical complications, the infectious samples taken did not reveal more fungal infections in the BF+ group. (4) Conclusions: fungal biliary contamination, although frequent, does not seem to increase the rate of global and infectious complications after PD, preceded by preoperative biliary drainage.

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Distinction of Risk Factors for Superficial vs Organ-Space Surgical Site Infections After Pancreatic Surgery

Cited by 38 publications

References 17 publications

Enhancing Patient Outcomes while Containing Costs after Complex Abdominal Operation: A Randomized Controlled Trial of the Whipple Accelerated Recovery Pathway

Enhancing Patient Outcomes while Containing Costs after Complex Abdominal Operation: A Randomized Controlled Trial of the Whipple Accelerated Recovery Pathway

Perioperative and anesthetic risk factors of surgical site infection in patients undergoing pancreaticoduodenectomy: A retrospective cohort study

Does Fungal Biliary Contamination after Preoperative Biliary Drainage Increase Postoperative Complications after Pancreaticoduodenectomy?

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