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Lin J, Peng Y, Guo L, Tao S, Li S, Huang W, Yang X, Qiao F, Zong Z. The incidence of surgical site infections in China. J Hosp Infect 2024; 146:206-223. [PMID: 37315807 DOI: 10.1016/j.jhin.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023]
Abstract
Surgical site infections (SSIs) are a common type of healthcare-associated infection. We performed a literature review to demonstrate the incidence of SSIs in mainland China based on studies since 2010. We included 231 eligible studies with ≥30 postoperative patients, comprising 14 providing overall SSI data regardless of surgical sites and 217 reporting SSIs for a specific site. We found that the overall SSI incidence was 2.91% (median; interquartile range: 1.05%, 4.57%) or 3.18% (pooled; 95% confidence interval: 1.85%, 4.51%) and the SSI incidence varied remarkably according to the surgical site between the lowest (median, 1.00%; pooled, 1.69%) in thyroid surgeries and the highest (median, 14.89%; pooled, 12.54%) in colorectal procedures. We uncovered that Enterobacterales and staphylococci were the most common types of micro-organisms associated with SSIs after various abdominal surgeries and cardiac or neurological procedures, respectively. We identified two, nine, and five studies addressing the impact of SSIs on mortality, the length of stay (LOS) in hospital, and additional healthcare-related economic burden, respectively, all of which demonstrated increased mortality, prolonged LOS, and elevated medical costs associated with SSIs among affected patients. Our findings illustrate that SSIs remain a relatively common, serious threat to patient safety in China, requiring more action. To tackle SSIs, we propose to establish a nationwide network for SSI surveillance using unified criteria with the aid of informatic techniques and to tailor and implement countermeasures based on local data and observation. We highlight that the impact of SSIs in China warrants further study.
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Affiliation(s)
- J Lin
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China; Department of Infectious Control, West China Hospital, Sichuan University, Chengdu, China
| | - Y Peng
- Department of Infectious Control, West China Hospital, Sichuan University, Chengdu, China
| | - L Guo
- Department of Infectious Control, West China Hospital, Sichuan University, Chengdu, China
| | - S Tao
- Department of Infectious Control, West China Hospital, Sichuan University, Chengdu, China
| | - S Li
- Department of Infectious Control, West China Hospital, Sichuan University, Chengdu, China
| | - W Huang
- Department of Infectious Control, West China Hospital, Sichuan University, Chengdu, China
| | - X Yang
- Southern Central Hospital of Yunnan Province, Honghe, China
| | - F Qiao
- Department of Infectious Control, West China Hospital, Sichuan University, Chengdu, China
| | - Z Zong
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China; Center for Pathogen Research, West China Hospital, Sichuan University, Chengdu, China.
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Pu JL, Xu X, Chen LL, Li C, Jia HD, Fan ZQ, Li JD, Guan MC, Liang YJ, Zhou YH, Wang XM, Gu WM, Wang H, Li J, Chen ZY, Chen TH, Zhang YM, Chen ZX, Yao LQ, Diao YK, Wang MD, Shen F, Pawlik TM, Lau WY, Chen Z, Yang T, Lv GY. Postoperative infectious complications following laparoscopic versus open hepatectomy for hepatocellular carcinoma: a multicenter propensity score analysis of 3876 patients. Int J Surg 2023; 109:2267-2275. [PMID: 37161522 PMCID: PMC10442085 DOI: 10.1097/js9.0000000000000446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Hepatocellular carcinoma (HCC) is a common indication for hepatectomy that is often complicated by postoperative complication. The authors sought to investigate the relationship between the open with laparoscopic approach of hepatectomy and incidences of postoperative infectious complications. PATIENTS AND METHODS Using a multicenter database, HCC patients who underwent laparoscopic hepatectomy (LH) or open hepatectomy (OH) were reviewed and analyzed. Propensity score matching (PSM), inverse probability of treatment weight (IPTW), and multivariate logistic regression analyses were utilized to assess the association of the operative approach with postoperative infectious complications, including incisional surgical site infection (SSI), organ/space SSI, and remote infection (RI). RESULTS Among 3876 patients, 845 (21.8%) and 3031 (78.2%) patients underwent LH and OH, respectively. The overall incidence of infection was 6.9 versus 14.6% among patients who underwent LH versus OH, respectively ( P <0.001). Of note, the incidences of incisional SSI (1.8 vs. 6.3%, P <0.001), organ/space SSI (1.8 vs. 4.6%, P <0.001), and RI (3.8 vs. 9.8%, P <0.001) were all significantly lower among patients who underwent LH versus OH. After PSM (6.9, 1.8, 1.8, and 3.8% vs. 18.5, 8.4, 5.2, and 12.8%, respectively) and IPTW (9.5, 2.3, 2.1, and 5.5% vs. 14.3, 6.3, 4.5, and 9.8%, respectively), LH remained associated with statistically lower incidences of all types of infectious complications. After adjustment for other confounding factors on multivariate analyses, LH remained independently associated with lower incidences of overall infection, incisional SSI, organ/space SSI, and RI in the overall, PSM, and IPTW cohorts, respectively. CONCLUSION Compared with open approach, laparoscopic approach was independently associated with lower incidences of postoperative infectious complications following hepatectomy for HCC.
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Affiliation(s)
- Jia-Le Pu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, Jilin
- Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong
| | - Xiao Xu
- Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong
| | - Lan-Lan Chen
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, Jilin
| | - Chao Li
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
| | - Hang-Dong Jia
- Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang
| | - Zhong-Qi Fan
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, Jilin
| | - Ju-Dong Li
- Department of Pancreatic-biliary Surgery, Changzheng Hospital
| | - Ming-Cheng Guan
- Department of Medical Oncology, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu
| | - Ying-Jian Liang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Harbin Medical University
| | - Ya-Hao Zhou
- Department of Hepatobiliary Surgery, Pu’er People’s Hospital, Pu’er, Yunnan
| | - Xian-Ming Wang
- Department of General Surgery, First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong
| | - Wei-Min Gu
- The First Department of General Surgery, the Fourth Hospital of Harbin, Harbin, Heilongjiang
| | - Hong Wang
- Department of General Surgery, Liuyang People’s Hospital, Liuyang, Hunan
| | - Jie Li
- Department of Hepatobiliary Surgery, Fuyang People’s Hospital, Fuyang
| | - Zhi-Yu Chen
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Ting-Hao Chen
- Department of General Surgery, Ziyang First People’s Hospital, Ziyang, Sichuan
| | - Yao-Ming Zhang
- The Second Department of Hepatobiliary Surgery, Meizhou People’s Hospital, Meizhou, Guangdong
| | - Zi-Xiang Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui
| | - Lan-Qing Yao
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
| | - Yong-Kang Diao
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
| | - Ming-Da Wang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
| | - Feng Shen
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Wan Yee Lau
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
- Faculty of Medicine, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Zhong Chen
- Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong
| | - Tian Yang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, Jilin
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
| | - Guo-Yue Lv
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, Jilin
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Gaszynski R, Wong P, Gray A, Diab J, Das A, Apostolou C, Merrett N. Loop and drain technique for prevention of surgical site infection in upper gastrointestinal surgery. ANZ J Surg 2022; 92:2143-2148. [PMID: 35903966 DOI: 10.1111/ans.17923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hepatobiliary and pancreatic surgery is frequently complicated by surgical site infections (SSI) with significant postoperative morbidity and mortality rates contributing to the economic burden on healthcare. Advancements in operative techniques to prevent SSI are gaining traction in clinical practice. This study compares the effectiveness of the 'loop and drain technique (LDT)', a combination method utilizing a continuous subcutaneous vessel loop and subcuticular suture for surgical wound closure in patients undergoing upper gastrointestinal surgery at a Metropolitan Hospital in Sydney. METHODS A retrospective review of patients who underwent an upper gastrointestinal procedure was conducted at Bankstown-Lidcombe hospital between 2017 and 2019. There were 77 patients in the LDT group and 123 patients included in the control group. The primary outcome assessed was the rate of SSI. Secondary outcomes included length of stay (LOS) and drainage of surgical site infections. RESULT Two hundred adult patients were treated for an upper gastrointestinal procedure. The most common operation was a Whipple procedure (35.0%). The rate of SSI was 12.5% with all these patients receiving intravenous antibiotics. The LDT cohort had a significantly lower rate of SSI compared to their counterparts (3.9% vs. 17.9%, P = 0.004). CONCLUSION The LDT method is associated with a decreased incidence of SSI and should be considered as a cost-effective operative technique to improve patient outcomes after upper gastrointestinal surgery.
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Affiliation(s)
- Rafael Gaszynski
- Division of General Surgery, Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - Pearl Wong
- Liverpool Hospital, Liverpool, Australia
| | - Andrew Gray
- Division of General Surgery, Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - Jason Diab
- Division of General Surgery, Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - Amitabha Das
- Division of General Surgery, Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - Christos Apostolou
- Division of General Surgery, Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - Neil Merrett
- Division of General Surgery, Bankstown-Lidcombe Hospital, Bankstown, Australia.,School of Medicine, Western Sydney University, Campbelltown, Australia
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Ishihara A, Tanaka S, Shinkawa H, Yoshida H, Takemura S, Amano R, Kimura K, Ohira G, Nishio K, Kubo S. Superiority of laparoscopic liver resection to open liver resection in obese individuals with hepatocellular carcinoma: A retrospective study. Ann Gastroenterol Surg 2022; 6:135-148. [PMID: 35106424 PMCID: PMC8786695 DOI: 10.1002/ags3.12506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 01/22/2023] Open
Abstract
AIM This study aimed to elucidate the effects of laparoscopic liver resection (LLR) vs open liver resection (OLR) for major complications (Clavien-Dindo classification grade ≥ IIIa) in obese individuals with hepatocellular carcinoma (HCC). METHODS The clinical records of 339 and 733 patients who underwent LLR and OLR, respectively, for HCC between 2000 and 2019 were retrospectively reviewed. Body mass index (BMI) groups were classified according to the definitions of the World Health Organization: underweight group, BMI ≤ 18.4 kg/m2 (LLR vs OLR: 27 vs 47); normal weight, BMI 18.5-24.9 kg/m2 (211 vs 483); overweight, BMI 25.0-29.9 kg/m2 (85 vs 181); and obese, BMI ≥ 30.0 kg/m2 (16 vs 22). The effects of obesity on major complications after LLR and OLR were investigated. RESULTS In total, 18 (5.3%) and 127 (17.3%) patients presented with major complications after LLR and OLR, respectively. There was no significant difference in the incidence of major complications after OLR in the four BMI groups. However, a stepwise decrease in the incidence of major complications after LLR was observed from the underweight to the obese group. In addition, a multivariate analysis revealed that increased BMI was an independent preventive factor for major complications after LLR (P = .026, odds ratio: 0.84). The estimated adjusted risk of major postoperative complications decreased with increased BMI in the LLR group, while the risk did not decrease in the OLR group (P for interaction = .048). CONCLUSION Laparoscopic liver resection is beneficial for obese patients and is superior to OLR.
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Affiliation(s)
- Atsushi Ishihara
- Department of Hepato-Biliary-Pancreatic Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Shogo Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Hiroji Shinkawa
- Department of Hepato-Biliary-Pancreatic Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Hisako Yoshida
- Department of Medical Statistics Osaka City University Graduate School of Medicine Osaka Japan
| | - Shigekazu Takemura
- Department of Hepato-Biliary-Pancreatic Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Ryosuke Amano
- Department of Hepato-Biliary-Pancreatic Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Kenjiro Kimura
- Department of Hepato-Biliary-Pancreatic Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Go Ohira
- Department of Hepato-Biliary-Pancreatic Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Kohei Nishio
- Department of Hepato-Biliary-Pancreatic Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery Osaka City University Graduate School of Medicine Osaka Japan
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Li JD, Diao YK, Li J, Wu H, Sun LY, Gu WM, Wang H, Chen TH, Zeng YY, Zhou YH, Wang Y, Zhang YM, Liang YJ, Lau WY, Li C, Liang L, Wang MD, Zhang CW, Shen F, Shao CH, Yang T. Association between preoperative prealbumin level and postoperative mortality and morbidity after hepatic resection for hepatocellular carcinoma: A multicenter study from a HBV-endemic area. Am J Surg 2020; 221:1024-1032. [PMID: 32951853 DOI: 10.1016/j.amjsurg.2020.08.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/24/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prealbumin is a more sensitive serum biomarker in reflecting liver function and nutritional status than albumin, because of its shorter half-life and its characteristics that could hardly be affected by supplemental venous infusion of albumin or blood transfusion. This study aimed to identify whether preoperative prealbumin level was associated with postoperative mortality and morbidity after hepatic resection for patients with hepatocellular carcinoma (HCC). METHODS From a Chinese multicenter database, patients who underwent hepatic resection for HCC were divided into the low and normal prealbumin groups by using 17 mg/dL as the cut-off level for serum prealbumin taken within a week before surgery. Using univariable and multivariable logistic regression analyses, independent predictors associated with postoperative 30-day and 90-day mortality, 30-day overall and major morbidity, and postoperative hepatic insufficiency were identified. RESULTS Among 1356 patients, 409 (30.2%) had a low preoperative prealbumin level. Postoperative 30-day and 90-day mortality, and 30-day overall and major morbidity in the low prealbumin group were significantly higher than the normal prealbumin group (2.9% vs. 0.5%, 5.1% vs. 1.5%, 35.7% vs. 18.4%, and 14.4% vs. 6.5%, respectively, all P < 0.001). Multivariable analyses identified that preoperative prealbumin level, but not albumin level, was independently associated with postoperative 30-day mortality (OR: 3.486, 95% CI: 1.184-10.265), 90-day mortality (2.504, 1.219-5.145), 30-day overall morbidity (1.727, 1.302-2.292), 30-day major morbidity (1.770, 1.155-2.711) and postoperative hepatic insufficiency (1.967, 1.119-3.427). CONCLUSIONS Preoperative prealbumin level could be used to predict postoperative morbidity and mortality for patients treated with hepatic resection for HCC.
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Affiliation(s)
- Ju-Dong Li
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China; Department of General Surgery, Changzheng Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Yong-Kang Diao
- Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Jie Li
- Department of Hepatobiliary Surgery, Fuyang People's Hospital, Anhui, China
| | - Han Wu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Li-Yang Sun
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Wei-Min Gu
- The First Department of General Surgery, The Fourth Hospital of Harbin, Heilongjiang, China
| | - Hong Wang
- Department of General Surgery, Liuyang People's Hospital, Hunan, China
| | - Ting-Hao Chen
- Department of General Surgery, Ziyang First People's Hospital, Sichuan, China
| | - Yong-Yi Zeng
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fujian, China
| | - Ya-Hao Zhou
- Department of Hepatobiliary Surgery, Pu'er People's Hospital, Yunnan, China
| | - Yu Wang
- Department of Hepatobiliary Surgery, Chongqing University Cancer Hospital, Chongqing, China
| | - Yao-Ming Zhang
- The 2nd Department of Hepatobiliary Surgery, Meizhou People's Hospital, Guangdong, China
| | - Ying-Jian Liang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Wan Yee Lau
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China; Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Chao Li
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Lei Liang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Ming-Da Wang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Cheng-Wu Zhang
- Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Feng Shen
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Cheng-Hao Shao
- Department of General Surgery, Changzheng Hospital, Second Military Medical University (Naval Medical University), Shanghai, China.
| | - Tian Yang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China.
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Tang TY, Zong Y, Shen YN, Guo CX, Zhang XZ, Zou XW, Yao WY, Liang TB, Bai XL. Predicting surgical site infections using a novel nomogram in patients with hepatocelluar carcinoma undergoing hepatectomy. World J Clin Cases 2019; 7:2176-2188. [PMID: 31531313 PMCID: PMC6718804 DOI: 10.12998/wjcc.v7.i16.2176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/22/2019] [Accepted: 07/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Surgical site infections (SSI) remain a major cause of morbidity after hepatectomy for hepatocellular carcinoma (HCC).
AIM To identify the risk factors associated with SSI, and develop a nomogram to predict SSI among patients undergoing hepatectomy.
METHODS We retrospectively reviewed the data of patients diagnosed with HCC undergoing hepatectomy at two academic institutions in China, and evaluated the occurrence of SSI. Independent risk factors for SSI were identified using univariate and multivariate analyses. Based on these independent risk factors, a nomogram was established using the data of patients in the first institution, and was validated using data from an external independent cohort from the second institution.
RESULTS The nomogram was established using data from 309 patients, whereas the validation cohort used data from 331 patients. The operation duration, serum albumin level, repeat hepatectomy, and ASA score were identified as independent risk factors. The concordance index (C-index) of the nomogram for SSI prediction in the training cohort was 0.86; this nomogram also performed well in the external validation cohort, with a C-index of 0.84. Accordingly, we stratified patients into three groups, with a distinct risk range based on the nomogram prediction, to guide clinical practice.
CONCLUSION Our novel nomogram offers good preoperative prediction for SSIs in patients undergoing hepatectomy.
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Affiliation(s)
- Tian-Yu Tang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Yi Zong
- The 5th Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 20000, China
| | - Yi-Nan Shen
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Cheng-Xiang Guo
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Xiao-Zhen Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Xiu-Wen Zou
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Wei-Yun Yao
- Department of Surgery, Changxing People’s Hospital, Huzhou 313000, Zhejiang Province, China
| | - Ting-Bo Liang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Xue-Li Bai
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
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Wang Z, Chen J, Wang P, Jie Z, Jin W, Wang G, Li J, Ren J. Surgical Site Infection After Gastrointestinal Surgery in China: A Multicenter Prospective Study. J Surg Res 2019; 240:206-218. [PMID: 30986636 DOI: 10.1016/j.jss.2019.03.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/13/2019] [Accepted: 03/18/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND There is no nationwide database of information on surgical site infection (SSI) after gastrointestinal surgery in China. This study aimed to determine the incidence of SSI after gastrointestinal surgery in China and evaluate the related risk factors. MATERIALS AND METHODS The multicenter, prospective, observational study enrolled adult patients who underwent gastrointestinal surgery from May 1, 2018 to June 30, 2018 in 30 hospitals in China. The demographic and perioperative characteristics were collected, and the primary outcome was 30-d SSI. Predictors of SSI were determined by multivariable logistic regressions. Subgroup analysis was performed to determine the predictors of SSI in different surgeries. RESULTS A total of 1290 patients were enrolled and SSI occurred in 68 patients (5.2%). Multivariate analysis with adjustments revealed that normal body mass index, normal blood glucose level, low national nosocomial infection surveillance risk index score, noncolon surgery, laparoscopic or robotic surgery, and use of mechanical bowel preparation were associated with reduced SSI in gastrointestinal surgery. Subgroup analysis revealed diverse predictors of SSI in diverse surgeries. National nosocomial infection surveillance risk index score of 2 and a high blood glucose level increased the incidence of SSI in colorectal and noncolorectal surgery, respectively. Besides, mechanical bowel preparation and laparoscopic or robotic surgery were protective factors for SSI in colorectal and noncolorectal surgery, respectively. CONCLUSIONS This study provides the newest data of SSI after gastrointestinal surgery in China and revealed some predictors of SSI in diverse surgeries, which can be a tool to look for areas to target quality improvement initiatives.
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Affiliation(s)
- Zhiwei Wang
- Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, P.R. China
| | - Jun Chen
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Peige Wang
- Department of Emergency General Surgery, The affiliated hospital of Qingdao University, Qingdao, P.R. China
| | - Zhigang Jie
- Department of General Surgery, Wuhan General Hospital of Guangzhou Military, Wuhan, P.R. China
| | - Weidong Jin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, P.R. China
| | - Gefei Wang
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Jieshou Li
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Jianan Ren
- Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, P.R. China; Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China.
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Kostakis ID, Machairas N, Prodromidou A, Garoufalia Z, Charalampoudis P, Sotiropoulos GC. Microbe Isolation from Blood, Central Venous Catheters, and Fluid Collections after Liver Resections. Surg Infect (Larchmt) 2018; 20:49-54. [PMID: 30300569 DOI: 10.1089/sur.2018.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Our goal was to evaluate the microbe species responsible for bacteremia or infections related to central venous catheter (CVC) or fluid collections after liver resection. PATIENTS AND METHODS Data from 112 patients (68 males, 44 females) who underwent liver resection over a period of 63 months were reviewed. Patient and tumor characteristics, intra-operative and post-operative data, and the results from cultures of peripheral blood, CVC tips and drained intra-abdominal or intra-throracic fluid collections were collected. RESULTS There were positive blood cultures in 20 patients (17.9%). Coagulase-negative staphylococci (CoNS) and bacteria of enteric flora were the micro-organisms found most frequently and half of the cases had multiple isolated microbe species. The construction of a bilioenteric anastomosis was an independent risk factor for microbe isolation in peripheral blood (odds ratio [OR]: 11, p = 0.01). Furthermore, there were positive cultures of the CVC tip in 14 patients (12.5%), with CoNS being the micro-organism found most frequently and most cases had only one isolated microbe species. No specific risk factor for catheter-related infections was detected. In addition, there were positive cultures of drained fluid collections in 19 patients (17%), with bacteria of enteric flora being the micro-organisms found most frequently and the majority of cases had multiple isolated microbe species. The construction of a bilioenteric anastomosis (OR: 23.5, p = 0.002) and the laparoscopic approach (OR: 4.7, p = 0.0496) were independent risk factors for microbe isolation in drained fluid collections. Finally, the presence of positive blood cultures was associated with the presence of positive culture of CVC tips (p = 0.018) and drained fluid collections (p = 0.001). CONCLUSIONS Post-operative bacteremia, colonization of CVCs, and contamination of fluid collections occur frequently after liver resections and various microbe species may be involved. Patients who undergo hepatectomy and a synchronous construction of a bilioenteric anastomosis are at increased risk of bacteremia development and contamination of fluid collections.
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Affiliation(s)
- Ioannis D Kostakis
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
| | - Anastasia Prodromidou
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
| | - Zoe Garoufalia
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
| | - Petros Charalampoudis
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
| | - Georgios C Sotiropoulos
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
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Tomita K, Chiba N, Ochiai S, Yokozuka K, Gunji T, Hikita K, Ozawa Y, Okihara M, Sano T, Tsutsui R, Shimazu M, Kawachi S. Superficial Surgical Site Infection in Hepatobiliary-Pancreatic Surgery: Subcuticular Suture Versus Skin Staples. J Gastrointest Surg 2018; 22:1385-1393. [PMID: 29633116 DOI: 10.1007/s11605-018-3754-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/20/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE Postoperative superficial surgical site infection is a major complication in hepatobiliary-pancreatic surgery. We aimed to compare the efficacy of subcuticular sutures versus staples for skin closure in preventing superficial surgical site infection in hepatobiliary-pancreatic surgery. METHODS Consecutive patients who underwent hepatobiliary-pancreatic surgery at our hospital from October 2006 to March 2011 and from April 2012 to March 2015 were reviewed retrospectively. Superficial surgical site infection incidence was evaluated in patients who received subcuticular sutures and those who received staples for skin closure. Propensity score matching analysis was used to adjust bias from confounding factors. RESULTS A total of 691 patients were included. Patients with skin staple closures (n = 346) were compared with patients with subcuticular suture closures (n = 345). After a propensity score matching analysis, a significant difference in superficial surgical site infection incidence was found between the skin stapler group (11.3%) and subcuticular sutures group (2.6%). The same comparison was performed by a subgroup analysis and supported this finding in patients after hepatectomy without biliary reconstruction, pancreatoduodenectomy, or open laparotomy surgeries and in patients with body mass index < 25. CONCLUSIONS Subcuticular suturing after hepatobiliary-pancreatic surgery was more efficacious in reducing postoperative superficial surgical site infection incidence than staples for skin closure.
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Affiliation(s)
- Koichi Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan.
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Shigeto Ochiai
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Kei Yokozuka
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Takahiro Gunji
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Kosuke Hikita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Yosuke Ozawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Masaaki Okihara
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Toru Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Rina Tsutsui
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Motohide Shimazu
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
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Mesohepatectomy Versus Extended Hemihepatectomies for Centrally Located Liver Tumors: A Meta-Analysis. Sci Rep 2017; 7:9329. [PMID: 28839257 PMCID: PMC5571172 DOI: 10.1038/s41598-017-09535-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 07/27/2017] [Indexed: 02/05/2023] Open
Abstract
The comparison of Mesohepatectomy (MH) with conventional extended hemihepatectomies (EH) for patients with centrally located liver tumors (CLLTs) were inconsistent. Our aims were to systemically compare MH with EH and to determine whether MH can achieve a similar clinical outcome as EH through this meta-analysis. PubMed/Medline, EMBASE, Web of Knowledge and Cochrane Library were searched updated to June 11, 2016. Blood loss and operation time favored MH in elder patients (mean difference [MD] for blood loss: -692.82 ml, 95% CI: -976.72 to -408.92 ml, P < 0.001; MD for operation time: -78.75 min, 95% CI: -107.66 to -49.81, P < 0.001). Morbidity rate (29.2%, 95% CI: 24.1 to 34.8%), mortality rate (2.0%, 95% CI: 1.2 to 3.3%) and overall survival (median OS 38.2 m, 95% CI: 34.0 to 42.8 m) of MH were comparable with those of EH. The low liver failure rate favored MH (odds ratio [OR]: 0.29, 95% CI: 0.09 to 0.88, P = 0.03). For MH, bile leakage was the most common surgical complication (MH vs. EH: 13.5% vs. 6.7%, P = 0.016), while for EH, it was wound infection (MH vs. EH: 6.9% vs. 15.7%, P < 0.001). Thus MH might be in general safe and feasible for treating CLLTs with a similar clinical outcome as EH.
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Li L, Ding J, Han J, Wu H. A nomogram prediction of postoperative surgical site infections in patients with perihilar cholangiocarcinoma. Medicine (Baltimore) 2017; 96:e7198. [PMID: 28640107 PMCID: PMC5484215 DOI: 10.1097/md.0000000000007198] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Surgical site infection (SSI) is one of the major morbidities after radical resection for perihilar cholangiocarcinoma (PHCC). This study aimed to clarify the risk factors and construct a nomogram to predict SSIs in patients with PHCC.A total of 335 consecutive patients who underwent hepatectomy combined with hepaticojejunostomy between January 2013 and December 2015 were analyzed retrospectively. SSIs, including incisional (superficial and deep) and space/organ infection, were defined according to the Centers for Disease Control and Prevention (CDC)'s National Nosocomial Infection Surveillance (NNIS) system. Risk factors associated with postoperative SSIs were analyzed by univariate and multivariate analyses. A nomogram was developed on the basis of results from the multivariate logistic model and the discriminatory ability of the model was analyzed.PHCC patients had higher organ/space SSI rate than incisional SSI rate after radical resection. Multivariate analysis showed that risk factors indicating postoperative overall SSIs (incisional and organ/space) included coexisting cholangiolithiasis [odds ratio (OR): 6.77; 95% confidence interval (95% CI): 2.40-19.11; P < .001], blood loss >1500 mL (OR: 4.77; 95% CI: 1.45-15.65; P = .010), having abdominal surgical history (OR: 5.85; 95% CI: 1.91-17.97; P = .002), and bile leakage (OR: 15.28; 95% CI: 5.90-39.62; P < .001). The β coefficients from the multivariate logistic model were used to construct the model for estimation of SSI risk. The scoring model was as follows: -4.12 +1.91 × (coexisting cholangiolithiasis = 1) + 1.77 × (having previous abdominal surgical history = 1) +1.56 × (blood loss >1500 mL = 1) + 2.73 × (bile leakage = 1). The discriminatory ability of the model was good and the area under the receiver operating characteristic (ROC) curve (AUC) was 0.851.In PHCC patients, there may be a relationship between postoperative SSIs and abdominal surgical history, coexisting cholangiolithiasis, bile leakage, and blood loss. The nomogram can be used to estimate the risk of postoperative SSIs in patients with PHCC.
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Affiliation(s)
- Long Li
- Department of General Surgery, Dingxi People's Hospital/Lanzhou University Second Hospital Dingxi Hospital
| | - Jie Ding
- Department of Hepatology, Lanzhou University Second Hospital, Lanzhou
| | - Jun Han
- Department of Critical Care Medicine, Sichuan Provincial Hospital for Women and Children
| | - Hong Wu
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
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12
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Wang Q, Yan J, Feng X, Chen G, Xia F, Li X, Ma K, Bie P. Safety and efficacy of radiofrequency-assisted ALPPS (RALPPS) in patients with cirrhosis-related hepatocellular carcinoma. Int J Hyperthermia 2017; 33:846-852. [PMID: 28540784 DOI: 10.1080/02656736.2017.1303752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has high morbidity and mortality. In this study, the safety and efficacy of a modification of ALPPS (radiofrequency-assisted ALPPS, RALPPS) were assessed in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS Patients who were diagnosed with HCC and were considered to have an insufficient future liver remnant (FLR) were enrolled. In stage I, a radiofrequency ablation (RFA) device was used to cauterise along the planned transection plane to form a coagulum avascular area. When the FLR reached above 40%, hepatectomy was performed in stage II along the coagulum area established previously. After two stages, operative morbidity, mortality, per cent increase in FLR, operative time and blood loss were evaluated. RESULTS Between July 2014 and September 2015, 10 patients with HCC (9 with hepatitis-related cirrhosis) were treated with the RALPPS procedure. The incidence of severe complications (Clavien-Dindo ≥ IIIb) was 20% (2/10). One patient died. No biliary leakage, intraperitoneal infection or post-hepatectomy liver failure (PHLF) occurred after both stages. The median FLR before stage I was 31% (364 ml). This increased to 47% (632 ml) before stage II after a median interval of 28 days. The median percentage increase in FLR was 53% (210 ml). Additionally, the median operative time during the first and second stages was 214 and 281 min, respectively. The corresponding median blood loss was 200 and 550 ml, respectively. CONCLUSIONS RALPPS has a potential advantage in eliminating serious complications of biliary leakage and PHLF associated with classic ALPPS. On the basis of rigorous patient selection criteria, RALPPS may achieve the same effect of promoting significant growth of the FLR in patients with cirrhosis-related HCC and insufficient FLR volume, albeit at the cost of a longer interval time.
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Affiliation(s)
- Qiang Wang
- a Institute of Hepatobiliary Surgery, Southwest Hospital , Third Military Medical University , Chongqing , P.R. China
| | - Jun Yan
- a Institute of Hepatobiliary Surgery, Southwest Hospital , Third Military Medical University , Chongqing , P.R. China
| | - Xiaobin Feng
- a Institute of Hepatobiliary Surgery, Southwest Hospital , Third Military Medical University , Chongqing , P.R. China
| | - Geng Chen
- a Institute of Hepatobiliary Surgery, Southwest Hospital , Third Military Medical University , Chongqing , P.R. China
| | - Feng Xia
- a Institute of Hepatobiliary Surgery, Southwest Hospital , Third Military Medical University , Chongqing , P.R. China
| | - Xiaowu Li
- a Institute of Hepatobiliary Surgery, Southwest Hospital , Third Military Medical University , Chongqing , P.R. China
| | - Kuansheng Ma
- a Institute of Hepatobiliary Surgery, Southwest Hospital , Third Military Medical University , Chongqing , P.R. China
| | - Ping Bie
- a Institute of Hepatobiliary Surgery, Southwest Hospital , Third Military Medical University , Chongqing , P.R. China
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Epidemiology and risk factors associated with surgical site infection after different types of hepatobiliary and pancreatic surgery. Surg Today 2017; 47:1208-1214. [PMID: 28303341 DOI: 10.1007/s00595-017-1503-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 02/07/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs); however, SSI after hepatobiliary and pancreatic surgery (HBPS) has not been well investigated in a large cohort of patients. This study analyzed the factors associated with SSI following HBPS in Japan, using a Japanese national database. METHODS Data on HBPS performed between 2012 and 2014 were extracted from a national monitoring system for HAI: The Japan Nosocomial Infections Surveillance. Using multivariate logistic regression, I assessed the factors associated with SSI. RESULTS The cumulative incidence of SSI following HBPS was 15.6% (2873/18,398). The incidence of SSI after pancreatoduodenectomy was 28.0%, which was significantly higher than that after liver resection and other types of HBPS (8.8 and 15.5%, respectively). Among the four traditional risk factors, the American Society of Anesthesiologists score was ineffective for predicting SSI in the final model of all three types of surgery. Additional risk factors were identified, including age and male gender. CONCLUSIONS The incidence of and factors associated with SSI after the three types of HBPS analyzed differed significantly. To accurately compare hospital performance in relation to SSI following HBPS, the operative procedure category in the surveillance system must be divided into three types.
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14
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Fukuda H. Patient-related risk factors for surgical site infection following eight types of gastrointestinal surgery. J Hosp Infect 2016; 93:347-54. [DOI: 10.1016/j.jhin.2016.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/11/2016] [Indexed: 12/29/2022]
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Dong ZM, Chidi AP, Goswami J, Han K, Simmons RL, Rosengart MR, Tsung A. Prior inpatient admission increases the risk of post-operative infection in hepatobiliary and pancreatic surgery. HPB (Oxford) 2015; 17:1105-12. [PMID: 26333471 PMCID: PMC4644362 DOI: 10.1111/hpb.12499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/16/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatobiliary and pancreatic (HPB) operations have a high incidence of post-operative nosocomial infections. The aim of the present study was to determine whether hospitalization up to 1 year before HPB surgery is associated with an increased risk of post-operative infection, surgical-site infection (SSI) and infection resistant to surgical chemoprophylaxis. METHODS A retrospective cohort study of patients undergoing HPB surgeries between January 2008 and June 2013 was conducted. A multivariable logistic regression model was used for controlling for potential confounders to determine the association between pre-operative admission and post-operative infection. RESULTS Of the 1384 patients who met eligibility criteria, 127 (9.18%) experienced a post-operative infection. Pre-operative hospitalization was independently associated with an increased risk of a post-operative infection [adjusted odds ratio (aOR): 1.61, 95% confidence interval [CI]: 1.06-2.46] and SSI (aOR: 1.79, 95% CI: 1.07-2.97). Pre-operative hospitalization was also associated with an increased risk of post-operative infections resistant to standard pre-operative antibiotics (OR: 2.64, 95% CI: 1.06-6.59) and an increased risk of resistant SSIs (OR: 3.99, 95% CI: 1.25-12.73). DISCUSSION Pre-operative hospitalization is associated with an increased incidence of post-operative infections, often with organisms that are resistant to surgical chemoprophylaxis. Patients hospitalized up to 1 year before HPB surgery may benefit from extended spectrum chemoprophylaxis.
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Affiliation(s)
- Zachary M Dong
- Department of Surgery, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Alexis P Chidi
- Department of Surgery, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Julie Goswami
- Department of Surgery, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Katrina Han
- Department of Surgery, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Richard L Simmons
- Department of Surgery, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Matthew R Rosengart
- Department of Surgery, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh School of MedicinePittsburgh, PA, USA
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