Postoperative infections represent a major determinant of outcome after pancreaticoduodenectomy: Results from a high-volume center

Pastena, Matteo De; Paiella, Salvatore; Marchegiani, Giovanni; Malleo, Giuseppe; Ciprani, Debora; Gasparini, Clizia; Secchettin, Erica; Salvia, Roberto; Bassi, Claudio

doi:10.1016/j.surg.2017.05.016

Cited by 76 publications

(77 citation statements)

References 53 publications

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“…It increased rapidly after POD3 and grew with the prolongation of drainage time. Multiple bacteria occurred in 40.6% of cases, which was also in line with the report by De Pastena and coworkers [24]. Sources of intraabdominal infection after PD include intraoperative contamination, retrograde contamination of the drain, anastomotic leakage, and intestinal bacterial translocation.…”

Section: Discussionsupporting

confidence: 88%

Clinical significance of drain fluid culture after pancreaticoduodenectomy

Yang

Jin

et al. 2018

J Hepato Biliary Pancreat

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Background The mechanism of infected postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy (PD) is undefined. Drain amylase has been used to predict POPF, whereas little data are available about the value of drain fluid culture. The aim was to investigate the incidence, risk factors and association with surgical outcomes of positive drainage culture (PDC) after PD. Methods A single‐center retrospective analysis was conducted of prospectively collected data from patients who underwent PD between January 2005 and December 2015. Drain fluid samples were obtained for microbiological analysis after surgery. Risk factors for PDC were evaluated, and its influence on surgical outcomes was explored. Results Of 768 patients, 261 (34%) had PDC during the postoperative period. Among them, a total of 434 isolates were yielded. One hundred and seven (24.7%) were Gram‐positive, 283 (65.2%) Gram‐negative, and 44 (10.1%) fungi. Multivariate analysis revealed that body mass index (BMI) ≥25 kg/m2, preoperative chemoradiation and intra‐operative red blood cell transfusion were independent risk factors for PDC. PDC was associated with higher incidences of complications including POPF, major complications and reoperation, but with no correlation between the day of PDC and complications. BMI ≥25 kg/m2, early PDC (≤3 days), main pancreatic duct <3 mm, and soft pancreas were revealed as independent predictors for POPF. There was a correlation between type of microorganisms and complications. Conclusion Considering the correlation between PDC and postoperative complications, preventive measures are crucial to improve outcomes after PD. Whether antibiotic treatment for early PDC will alter the clinical course of POPF needs further evaluation.

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Section: Discussionsupporting

confidence: 88%

Clinical significance of drain fluid culture after pancreaticoduodenectomy

Yang

Jin

et al. 2018

J Hepato Biliary Pancreat

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“…In particular, they have been associated with an increased risk of surgical site infection and abdominal collections. 25,26 It must be emphasized that data published so far comes from heterogeneous studies; most of them were retrospective, with small numbers of patients or in the former era of percutaneous drainage of the biliary tree. The most recent randomized controlled trial has shown that PBD increases the rate of complications after PD.…”

Section: O Bstructive Jaundice Is a Common Clinicalmentioning

confidence: 99%

Impact of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: An analysis of 1500 consecutive cases

Pastena¹,

Marchegiani²,

Paiella³

et al. 2018

Digestive Endoscopy

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“…These complications are also responsible for prolonged hospital admissions and greater healthcare expenditure [1,2,6]. A postoperative complication following cancer surgery is associated with shorter disease-free survival and reduced overall survival [7][8][9][10]. This is possibly caused by an immunomodulation effect of the postoperative complication [10].…”

Section: Introductionmentioning

confidence: 99%

A Model for Assessment of Peri-Operative Outcomes Following Hepato-Pancreatic and Biliary Surgery

Mirza¹,

Pannu²,

Lawrence³

et al. 2020

COR

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Hepato-pancreatic and biliary surgery is associated with significant morbidity and mortality. A large number of these complications can be avoided and promote better outcomes. Peri-operative complications can have significant impact on the overall cost of the procedure. Number of steps can be adopted in the post-procedure phase with accurate documentation, stratification, classification and categorisation of complications. This will help to monitor departmental surgical outcomes and necessary steps that can be adopted to improve patient safety. This study will aim to propose a structure to record post-operative surgical complications following hepato-pancreatic and biliary (HPB) surgery. This record keeping and reflection will help to improve patient care and outcome.

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Postoperative infections represent a major determinant of outcome after pancreaticoduodenectomy: Results from a high-volume center

Cited by 76 publications

References 53 publications

Clinical significance of drain fluid culture after pancreaticoduodenectomy

Clinical significance of drain fluid culture after pancreaticoduodenectomy

Impact of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: An analysis of 1500 consecutive cases

A Model for Assessment of Peri-Operative Outcomes Following Hepato-Pancreatic and Biliary Surgery

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