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Ma Y, Tan B, Wang S, Ren C, Zhang J, Gao Y. Influencing factors and predictive model of postoperative infection in patients with primary hepatic carcinoma. BMC Gastroenterol 2023; 23:123. [PMID: 37046206 PMCID: PMC10099730 DOI: 10.1186/s12876-023-02713-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/07/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The purpose of this study was to explore the risk factors for postoperative infection in patients with primary hepatic carcinoma (PHC), build a nomogram prediction model, and verify the model to provide a better reference for disease prevention, diagnosis and treatment. METHODS This single-center study included 555 patients who underwent hepatobiliary surgery in the Department of Hepatobiliary Surgery of Tianjin Third Central Hospital from January 2014 to December 2021, and 32 clinical indicators were selected for statistical analysis. In this study, Lasso logistic regression was used to determine the risk factors for infection after liver cancer resection, establish a predictive model, and construct a visual nomogram. The consistency index (C-index), calibration curve, and receiver operating characteristic (ROC) curve were used for internal validation, and decision curve analysis (DCA) was used to analyze the clinical applicability of the predictive model. The bootstrap method was used for intramodel validation, and the C-index was calculated to assess the model discrimination. RESULTS Among the 555 patients, 279 patients met the inclusion criteria, of whom 48 had a postoperative infection, with an incidence rate of 17.2%. Body mass index (BMI) (P = 0.022), alpha-fetoprotein (P = 0.023), total bilirubin (P = 0.016), intraoperative blood loss (P < 0.001), and bile leakage (P < 0.001) were independent risk factors for infection after liver cancer surgery. The nomogram was constructed and verified to have good discriminative and predictive ability. DCA showed that the model had good clinical applicability. The C-index value verified internally by the bootstrap method results was 0.818. CONCLUSION Postoperative infection in patients undergoing hepatectomy may be related to risk factors such as BMI, preoperative AFP level, TBIL level, intraoperative blood loss and bile leakage. The prediction model of the postoperative infection nomogram established in this study can better predict and estimate the risk of postoperative infection in patients undergoing hepatectomy.
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Affiliation(s)
- Yanan Ma
- Department of Clinical Laboratory, Nankai University Affiliated Third Center Hospital, Tianjin, 300170, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin Institute of Hepatobiliary Disease, Nankai University Affiliated Third Center Hospital, Jintang Road 83, Hedong District, Tianjin, 300170, China
| | - Bing Tan
- Department of Clinical Laboratory, Nankai University Affiliated Third Center Hospital, Tianjin, 300170, China
| | - Sumei Wang
- Department of Clinical Laboratory, Nankai University Affiliated Third Center Hospital, Tianjin, 300170, China
| | - Chaoyi Ren
- Department of Hepatobiliary Surgery, Nankai University Affiliated Third Center Hospital, Tianjin, 300170, China
| | - Jiandong Zhang
- Department of Clinical Laboratory, Nankai University Affiliated Third Center Hospital, Tianjin, 300170, China
| | - Yingtang Gao
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin Institute of Hepatobiliary Disease, Nankai University Affiliated Third Center Hospital, Jintang Road 83, Hedong District, Tianjin, 300170, China.
- Artificial Cell Engineering Technology Research Center, Tianjin, 300170, China.
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2
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Aguirre-Allende I, Alkorta-Zuloaga M, Iglesias-Gaspar MT, Urreta-Ballobre I, García-Domínguez A, Arteaga-Martin X, Beguiristain-Gómez A, Medrano-Gómez MÁ, Ruiz-Montesinos I, Riverola-Aso AP, Jiménez-Agüero R, Enríquez-Navascués JM. Subcuticular suture and incisional surgical-site infection in elective hepatobiliary and pancreatic surgery: an open-label, pragmatic randomized clinical trial (CLOSKIN trial). BMC Surg 2023; 23:9. [PMID: 36639756 PMCID: PMC9837932 DOI: 10.1186/s12893-023-01911-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Subcuticular suture has proven to reduce superficial incisional SSI (si-SSI) in clean surgery. However, question remains regarding clean-contaminated procedures. The aim of this study is to assess if subcuticular suture is superior to staples in reducing si-SSI incidence in elective HBP surgery. METHODS Single-centre, open-label, parallel, pragmatic randomized clinical trial conducted at a referral tertiary Hospital between January 2020 and April 2022. Patients eligible for elective HBP surgery were randomly assigned (1:1) to subcuticular suture or surgical staples wound closure using a minimisation method based on previously confirmed risk factors. The primary endpoint was the incidence of si-SSI. Considered secondary endpoints were major postoperative morbidity in both groups, additional wound complications, median hospital length of stay and need for re-hospitalisation. RESULTS Of the 379 patients, 346 patients were randomly assigned to receive skin closure with staples (n = 173) or subcuticular suture (n = 173). After further exclusion of 11 participants, 167 and 168 patients, respectively in the control and the experimental group received their allocated intervention. For the primary endpoint, no significant differences in si-SSI rate were found: 17 (9.82%) staples group vs. 8 (4.62%) in subcuticular suture group (p = 0.062). Subset analysis confirmed absence of significant differences. As for secondary endpoints, overall wound complications did not differ significantly between two procedures: 19 (10.98%) vs. 10 (6.35%) (p = 0.127). There were no treatment related adverse events. However, occurrence of si-SSI contributed to major postoperative morbidity in both groups (p < 0.001 and p = 0.018) and to a substantially prolonged postoperative hospitalization (p = 0.015). CONCLUSIONS Subcuticular suture might offer a relative benefit for skin closure reducing incidence of si-SSI after elective HBP surgery, although this was found not to be clinically relevant. Yet, this should not be interpreted as equivalence among both treatments. Therefore, wound closure strategy should not be based only on these grounds. TRIAL REGISTRATION NUMBER ISRCTN Registry number ISRCTN37315612 (registration date: 14/01/2020).
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Affiliation(s)
- Ignacio Aguirre-Allende
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Maialen Alkorta-Zuloaga
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Maria Teresa Iglesias-Gaspar
- grid.414651.30000 0000 9920 5292Clinical Epidemiology Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Iratxe Urreta-Ballobre
- grid.414651.30000 0000 9920 5292Clinical Epidemiology Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Amaia García-Domínguez
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Xabier Arteaga-Martin
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Adolfo Beguiristain-Gómez
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Miguel Ángel Medrano-Gómez
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Inmaculada Ruiz-Montesinos
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Ana Paula Riverola-Aso
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Raúl Jiménez-Agüero
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - José María Enríquez-Navascués
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Colorectal Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
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Zubenko SI, Monakhov AR, Boldyrev MA, Salimov VR, Smolianinova AD, Gautier SV. Risk factors in deceased donor liver transplantation: a single centre experience. RUSSIAN JOURNAL OF TRANSPLANTOLOGY AND ARTIFICIAL ORGANS 2022. [DOI: 10.15825/1995-1191-2022-4-7-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Deceased brain-dead donor liver transplantation (LT) is a high-risk intervention. The outcome depends on a large number of modifiable and non-modifiable factors. Objective: to analyze our own experience and identify preoperative and perioperative prognostic factors for poor outcomes in LT. Materials and methods. The study included 301 liver transplants performed between January 2016 and December 2021. Donor and recipient characteristics, intraoperative data, perioperative characteristics including laboratory test data, and the nature and frequency of complications were used for the analysis. Results. The 1-, 3- and 5-year recipient survival rates were 91.8%, 85.1%, and 77.9%, respectively; graft survival rates were 90.4%, 83.7%, and 76.7%, respectively. The most significant predictors of poor outcome of LT on the recipient side were biliary stents (HR 7.203, p < 0.01), acutely decompensated cirrhosis (HR 2.52, p = 0.02); in the postoperative period, non-surgical infectious complications (HR 4.592, p < 0.01) and number of reoperations (HR 4.063, p < 0.01). Donor creatinine level (HR 1.004, p = 0.01, one factor analysis; HR 1.004, p = 0.016, multivariate analysis) was the only reliable prognostic negative factor. Conclusion. LT taking into account established risk factors will improve surgery outcomes and help personalize the therapy for each patient.
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Affiliation(s)
- S. I. Zubenko
- Shumakov National Medical Research Center of Transplantology and Artificial Organs
| | - A. R. Monakhov
- Shumakov National Medical Research Center of Transplantology and Artificial Organs; Sechenov University
| | - M. A. Boldyrev
- Shumakov National Medical Research Center of Transplantology and Artificial Organs
| | - V. R. Salimov
- Shumakov National Medical Research Center of Transplantology and Artificial Organs
| | - A. D. Smolianinova
- Shumakov National Medical Research Center of Transplantology and Artificial Organs
| | - S. V. Gautier
- Shumakov National Medical Research Center of Transplantology and Artificial Organs; Sechenov University
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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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Bacterial flora in the bile: Clinical implications and sensitivity pattern from a tertiary care centre. Indian J Med Microbiol 2020; 39:30-35. [PMID: 33610253 DOI: 10.1016/j.ijmmb.2020.10.008] [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: 11/21/2022]
Abstract
BACKGROUND Though preoperative biliary drainage (PBD) has been suggested to be linked with increased perioperative morbidity it is still practiced commonly. We studied the association of PBD and positive biliary culture with surgical site infection and also analysed the common pathogens and their antibiotic sensitivity spectrum. METHODS Prospectively maintained data of patients who underwent various pancreatobiliary surgeries from 2017 to 2019 was analysed. Patients whose intraoperative bile culture reports were available were included in the study. Various factors associated with surgical site infection (SSI), microbial spectrum of bile culture and their sensitivity pattern were analysed. RESULTS Out of 68 patients whose bile culture report were available, PBD was done in 65% (n = 44). Among patients with infected bile (n = 51), biliary stent was present in 78.4% (n = 40). On univariate analysis, the factors associated with SSI were low albumin level (<3.5 mg%), long operative time (>6 h), duration of abdominal drain (>4 days), length of hospital stay, intraoperative bile spillage and infected bile. However, on multivariate analysis, only presence of drain for >4 days (p = 0.04) and positive bile culture (p = 0.02) was linked with increased risk of SSI. Most common organism isolated was E coli (73.2%), with 100% sensitivity to Colistin and Tigecycline shown by gram negative isolates. CONCLUSION Preoperative biliary stenting alone did not increase the risk of SSI, but the positive bile culture correlated with SSI irrespective of PBD. Most biliary pathogens were resistant to commonly used antibiotics and intraoperative bile culture will aid in providing appropriate antibiotic coverage.
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van Niekerk JM, Vos MC, Stein A, Braakman-Jansen LMA, Voor in ‘t holt AF, van Gemert-Pijnen JEWC. Risk factors for surgical site infections using a data-driven approach. PLoS One 2020; 15:e0240995. [PMID: 33112893 PMCID: PMC7592760 DOI: 10.1371/journal.pone.0240995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022] Open
Abstract
Objective The objective of this study was to identify risk factors for surgical site infection from digestive, thoracic and orthopaedic system surgeries using clinical and data-driven cut-off values. A second objective was to compare the identified risk factors in this study to risk factors identified in literature. Summary background data Retrospective data of 3 250 surgical procedures performed in large tertiary care hospital in The Netherlands during January 2013 to June 2014 were used. Methods Potential risk factors were identified using a literature scan and univariate analysis. A multivariate forward-step logistic regression model was used to identify risk factors. Standard medical cut-off values were compared with cut-offs determined from the data. Results For digestive, orthopaedic and thoracic system surgical procedures, the risk factors identified were preoperative temperature of ≥38°C and antibiotics used at the time of surgery. C-reactive protein and the duration of the surgery were identified as a risk factors for digestive surgical procedures. Being an adult (age ≥18) was identified as a protective effect for thoracic surgical procedures. Data-driven cut-off values were identified for temperature, age and CRP which can explain the SSI outcome up to 19.5% better than generic cut-off values. Conclusions This study identified risk factors for digestive, orthopaedic and thoracic system surgical procedures and illustrated how data-driven cut-offs can add value in the process. Future studies should investigate if data-driven cut-offs can add value to explain the outcome being modelled and not solely rely on standard medical cut-off values to identify risk factors.
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Affiliation(s)
- J. M. van Niekerk
- Department of Psychology, Health and Technology/Centre for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, The Netherlands
- Department of Earth Observation Sciences, Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, Enschede, The Netherlands
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - M. C. Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - A. Stein
- Department of Earth Observation Sciences, Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, Enschede, The Netherlands
| | - L. M. A. Braakman-Jansen
- Department of Psychology, Health and Technology/Centre for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, The Netherlands
- * E-mail:
| | - A. F. Voor in ‘t holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - J. E. W. C. van Gemert-Pijnen
- Department of Psychology, Health and Technology/Centre for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, The Netherlands
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Brennfleck FW, Bachmeier T, Simet W, Zeman F, Junger HHG, Schlitt HJ, Dahlke MH, Brunner SM. Surgical Site Infections and their economic significance in hepatopancreatobiliary surgery: A retrospective incidence, cost, and reimbursement analysis in a German centre of the highest level of care. Int Wound J 2020; 18:17-23. [PMID: 33006236 PMCID: PMC7948679 DOI: 10.1111/iwj.13511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022] Open
Abstract
Surgical site infections (SSI) in open Hepatopancreatobiliary (HPB) surgery are common complications. They worsen patients’ outcomes and prolong hospital stays. Their economic significance in the German diagnosis related groups (DRG) system is mostly unknown. To investigate their economic importance, we evaluated all cases for SSIs as well as clinical and financial parameters undergoing surgery in our centre from 2015 and 2016. Subsequently, we carried out a cost‐revenue calculation by assessing our billing data and the cost matrix of the InEK (German Institute for the Payment System in Hospitals). A total of 13.5% of the patients developed a superficial, 9% a deep incisional, and 2.4% of the patients an organ space SSI. Compared with Patients without SSI, Patients with SSI had more comorbidities, were older, and their average length of stay was extended by 19 days (P < .001). The financial loss per SSI‐case was €‐7035.65 despite increased reimbursement, which resulted in a calculated total loss for the hospital of €‐802 064.62 in 2015 and 2016. Surgical site infections are common complications of open HPB surgery, which lead to a significant increase in the cost per case. Further prevention strategies need to be developed. Besides, an adjustment of revenues must be demanded.
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Affiliation(s)
| | - Tanja Bachmeier
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Wolfgang Simet
- Financial Department, University Medical Center Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | | | - Hans Jürgen Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Marc-Hendrik Dahlke
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany.,Department of Surgery, Robert-Bosch-Klinikum, Stuttgart, Germany
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Mentor K, Ratnayake B, Akter N, Alessandri G, Sen G, French JJ, Manas DM, Hammond JS, Pandanaboyana S. Meta-Analysis and Meta-Regression of Risk Factors for Surgical Site Infections in Hepatic and Pancreatic Resection. World J Surg 2020; 44:4221-4230. [PMID: 32812136 DOI: 10.1007/s00268-020-05741-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The risk factors for surgical site infection (SSI) after HPB surgery are poorly defined. This meta-analysis aimed to quantify the SSI rates and risk factors for SSI after pancreas and liver resection. METHODS The PUBMED, MEDLINE and EMBASE databases were systematically searched using the PRISMA framework. The primary outcome measure was pooled SSI rates. The secondary outcome measure was risk factor profile determination for SSI. RESULTS The overall rate of SSI after pancreatic and liver resection was 25.1 and 10.4%, respectively (p < 0.001). 32% of pancreaticoduodenectomies developed SSI vs 23% after distal pancreatectomy (p < 0.001). The rate of incisional SSI in the pancreatic group was 9% and organ/space SSI 16.5%. Biliary resection during liver surgery was a risk factor for SSI (25.0 vs 15.7%, p = 0.002). After liver resection, the incisional SSI rate was 7.6% and the organ space SSI rate was 10.2%. Pancreas-specific SSI risk factors were pre-operative biliary drainage (p < 0.001), chemotherapy (p < 0.001) and radiotherapy (p = 0.007). Liver-specific SSI risk factors were smoking (p = 0.046), low albumin (p < 0.001) and significant blood loss (p < 0.001). The rate of organ/space SSI in patients with POPF was 47.7% and in patients without POPF 7.3% (p < 0.001). Organ/space SSI rate was 43% in patients with bile leak and 10% in those without (p < 0.001). CONCLUSIONS The risk factors for SSI following pancreatic and liver resections are distinct from each other, with higher SSI rates after pancreatic resection. Pancreaticoduodenectomy has increased risk of SSI compared to distal pancreatectomy. Similarly, biliary resections during liver surgery increase the rates of SSI.
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Affiliation(s)
- Keno Mentor
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bathiya Ratnayake
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nasreen Akter
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Giorgio Alessandri
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gourab Sen
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jeremy J French
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Derek M Manas
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John S Hammond
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sanjay Pandanaboyana
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. .,Population Health Science Institute, Newcastle University, Newcastle upon Tyne, UK.
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Guetta O, Vakhrushev A, Dukhno O, Ovnat A, Sebbag G. New results on the safety of laparoscopic sleeve gastrectomy bariatric procedure for type 2 diabetes patients. World J Diabetes 2019; 10:78-86. [PMID: 30788045 PMCID: PMC6379729 DOI: 10.4239/wjd.v10.i2.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/08/2019] [Accepted: 01/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It has been established that bariatric surgery, including laparoscopic sleeve gastrectomy (LSG), has a positive impact on type 2 diabetes mellitus (T2DM). However, less frequently T2DM is reported as a risk factor for complications with this type of surgery.
AIM To evaluate the safety of LSG in T2DM.
METHODS A retrospective cohort study was conducted over patients admitted for LSG from January 2008 to May 2015. Data was collected through digitized records. Any deviation from normal postoperative care within the first 60 d was defined as an early complication, and further categorized into mild or severe.
RESULTS Nine hundred eighty-four patients underwent LSG, among these 143 (14.5%) were diagnosed with T2DM. There were 19 complications in the T2DM group (13.3%) compared to 59 cases in the non-T2DM (7.0%). Out of 19 complications in the T2DM group, 12 were mild (8.4%) and 7 were severe (4.9%). Compared to the non-T2DM group, patients had a higher risk for mild complications (Odds-ratio 2.316, CI: 1.163-4.611, P = 0.017), but not for severe ones (P = 0.615). An increase of 1% in hemoglobin A1c levels was associated with a 40.7% increased risk for severe complications (P = 0.013, CI: 1.074-1.843) but not for mild ones.
CONCLUSION Our data suggest that LSG is relatively safe for patients with T2DM. Whether pre-operative control of hemoglobin A1c level will lower the complications rate has to be prospectively studied.
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Affiliation(s)
- Ohad Guetta
- Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
| | - Alex Vakhrushev
- Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
| | - Oleg Dukhno
- Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
| | - Amnon Ovnat
- Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
| | - Gilbert Sebbag
- Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
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Berger I, Xia L, Wirtalla C, Dowzicky P, Guzzo TJ, Kelz RR. 30-day readmission after radical cystectomy: Identifying targets for improvement using the phases of surgical care. Can Urol Assoc J 2018; 13:E190-E201. [PMID: 30472980 DOI: 10.5489/cuaj.5455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Postoperative readmissions following radical cystectomy (RC) have gained attention in the past decade. Postoperative and post-discharge complications play a role in readmission rates; however, our ability to predict readmissions remains poor. METHODS Using the National Surgical Quality Improvement Program database, we identified patients with bladder cancer undergoing RC from 2013-2015. Complications were defined as postoperative and post-discharge. Outcomes were 30-day readmission, post-discharge complications, and post-discharge major complications. Patient, operative, and complication factors were assessed using multivariable logistic regression. RESULTS We identified 4457 patients who underwent RC; 9.2% of patients experienced a postoperative complication, 18.8% experienced a post-discharge complication, and 20.3% were readmitted. Overweight and obese body mass index (BMI), dependent functional status, chronic obstructive pulmonary disease (COPD), a continent diversion, and duration of operation were associated with post-discharge complications. Postoperative complications were not associated with post-discharge complications. Readmission was associated with Black race (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.0-2.1), overweight (OR 1.5; 95% CI 1.2-1.8) and obese BMI (OR 1.5; 95% CI 1.2-1.9), diabetes (OR 1.2; 95% CI 1.0-1.5), COPD (OR 1.4; 95% CI 1.0-1.8), steroid use (OR 1.5; 95% CI 1.0-2.2), a continent diversion (OR 1.4; 95% CI 1.1-1.7), duration of operation (OR 1.1; 95% CI 1.1-1.2), and postoperative complications (OR 1.5; 95% CI 1.2-2.0). The majority of readmissions experienced a post-discharge complication. CONCLUSIONS Factors that span the preoperative, intraoperative, postoperative, and post-discharge phases of care were identified to increase readmission risk. To improve readmission rates, interventions will have to target factors across the surgical experience.
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Affiliation(s)
- Ian Berger
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.,Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Leilei Xia
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Christopher Wirtalla
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Phillip Dowzicky
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.,Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Rachel R Kelz
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.,Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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11
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Takahashi Y, Takesue Y, Fujiwara M, Tatsumi S, Ichiki K, Fujimoto J, Kimura T. Risk factors for surgical site infection after major hepatobiliary and pancreatic surgery. J Infect Chemother 2018; 24:739-743. [PMID: 30001844 DOI: 10.1016/j.jiac.2018.05.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/21/2018] [Accepted: 05/20/2018] [Indexed: 02/07/2023]
Abstract
Major hepatobiliary and pancreatic (HP) surgeries are complex procedures associated with a high incidence of surgical site infection (SSI) and are commonly performed in patients with cancer in Japan. This study was performed to investigate the risk factors for SSI, including incisional and organ/space SSI, in HP surgery. The following procedures were included in the study: hepatectomy with and without biliary tract resection, pancreatectomy [pancreaticoduodenectomy (PD), others], and open cholecystectomy. In total, 735 patients were analyzed. The incidence of SSI was 17.8% (incisional, 5.2%; organ/space, 15.5%; both 2.9%). The highest incidence of SSI was observed in patients who underwent hepatectomy with biliary tract resection (39.1%), followed by pancreatectomy (PD, 28.8%; others, 29.8%). Almost all SSIs after these three procedures were classified as organ/space (39.1%, 25.0%, and 27.7%, respectively), and these procedures were risk factors for not only total SSI but also organ/space SSI in the multivariate analysis. An American Society of Anesthesiologists physical status of ≥3 was a risk factor for incisional SSI. Preoperative biliary drainage, prolonged surgery, concomitant surgery, and massive intraoperative bleeding were associated with SSI. In conclusion, the main type of SSI was organ/space SSI after HP surgery, and different risk factors were identified between organ/space and incisional SSI. Procedure-related factors and preoperative biliary drainage were independent risk factors for SSI. To prevent SSI, the indication for preoperative biliary drainage should be carefully evaluated in patients undergoing HP surgery.
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Affiliation(s)
- Yoshiko Takahashi
- Department of Pharmacy, Hospital of Hyogo College of Medicine, Hyogo, Japan.
| | - Yoshio Takesue
- Department of Infection Prevention and Control, Hyogo College of Medicine, Hyogo, Japan
| | | | - Sumiyo Tatsumi
- Department of Pharmacy, Hospital of Hyogo College of Medicine, Hyogo, Japan
| | - Kaoru Ichiki
- Department of Infection Prevention and Control, Hyogo College of Medicine, Hyogo, Japan
| | - Jiro Fujimoto
- Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Takeshi Kimura
- Department of Pharmacy, Hospital of Hyogo College of Medicine, Hyogo, Japan
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12
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Harnoss JC, Assadian O, Kramer A, Probst P, Müller-Lantzsch C, Scheerer L, Bruckner T, Diener MK, Büchler MW, Ulrich AB. Comparison of chlorhexidine–isopropanol with isopropanol skin antisepsis for prevention of surgical-site infection after abdominal surgery. Br J Surg 2018; 105:893-899. [DOI: 10.1002/bjs.10793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/11/2017] [Accepted: 11/17/2017] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Prevention of surgical-site infection (SSI) has received increasing attention. Clinical trials have focused on the role of skin antisepsis in preventing SSI. The benefit of combining antiseptic chlorhexidine with alcohol has not been compared with alcohol-based skin preparation alone in a prospective controlled clinical trial.
Methods
Between August and October 2014, patients undergoing abdominal surgery received preoperative skin antisepsis with 70 per cent isopropanol (PA). Those treated between November 2014 and January 2015 received 2 per cent chlorhexidine with 70 per cent isopropanol (CA). The primary endpoint was SSI on postoperative day (POD) 10, which was evaluated using univariable analysis, and a multivariable logistic regression model correcting for known independent risk factors for SSI. The study protocol was published in the German Registry of Clinical Studies (DRKS00011174).
Results
In total, 500 patients undergoing elective midline laparotomy were included (CA 221, PA 279). The incidence of superficial and deep SSIs was significantly different on POD 10: 14 of 212 (6·6 per cent) among those treated with CA and 32 of 260 (12·3 per cent) in those who received PA (P = 0·038). In the multivariable analysis, skin antisepsis with CA was an independent factor for reduced incidence of SSI on POD 10 (P = 0·034).
Conclusion
This study showed a benefit of adding chlorhexidine to alcohol for skin antisepsis in reducing early SSI compared with alcohol alone.
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Affiliation(s)
- J C Harnoss
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - O Assadian
- Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
| | - A Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - P Probst
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - C Müller-Lantzsch
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - L Scheerer
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - T Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - M K Diener
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - A B Ulrich
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
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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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Preoperative biliary drainage in hilar cholangiocarcinoma: Systematic review and meta-analysis. Eur J Surg Oncol 2017; 43:1628-1635. [PMID: 28477976 DOI: 10.1016/j.ejso.2017.04.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/14/2017] [Accepted: 04/04/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The role of preoperative biliary drainage (PBD) for hilar cholangiocarcinoma (HCC) remains unclear. The aim of this meta-analysis is to investigate the role of PBD in the treatment of potentially resectable HCC. METHODS All studies reporting outcomes on patients with PBD vs without PBD were included. A systematic literature search was performed in PubMed, Embase, and the Cochrane Library for studies published between 1980 and 2016. RESULTS Initial search identified 667 articles. Only 9 studies met the inclusion criteria and were included in this analysis. No significant differences in mortality were observed between the two groups (RR = 0,935; 95% CI = 0,612 to 1429; p = 0,463). Overall morbidity was significantly higher in PBD group (RR = 1266; 95% CI = 1039 to 1543; p = 0,011). No significant differences in transfusion rate, hospital stay, anastomotic leaks, abdominal collections and operative time, were found. Wound infections were significantly higher in PBD group. CONCLUSIONS PBD seems to be associated with higher postoperative morbidity and increases the risk of wound infections. Further prospective studies are needed to better define the impact of PBD in outcomes after surgery for hilar cholangiocarcinoma.
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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: 30] [Impact Index Per Article: 4.3] [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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