The effect of prolonged antibiotics on postoperative complications for common bile duct stones: A post hoc analysis of an EAST multicenter study

Broad vs Narrow Spectrum Antibiotics in Common Bile Duct Stones: A Post Hoc Analysis of an Eastern Association for the Surgery of Trauma Multicenter Study

BACKGROUND

Antimicrobial guidance for common bile duct stones during the perioperative period is limited. We sought to examine the effect of broad-spectrum (BS) vs narrow-spectrum (NS) antibiotics on surgical site infections (SSIs) in patients with common bile duct stones undergoing same-admission cholecystectomy.

STUDY DESIGN

We performed a post hoc analysis of a prospective, observational, multicenter study of patients undergoing same-admission cholecystectomy for choledocholithiasis and/or acute biliary pancreatitis between 2016 and 2019. We excluded patients with cholangitis, perforated cholecystitis, and nonbiliary infections on admission. Patients were divided based on receipt of BS or NS antibiotics. Our primary outcome was the incidence of SSIs, and secondary outcomes included hospital length of stay, acute kidney injury (AKI), and 30-day readmission for SSI.

RESULTS

The cohort had 891 patients: 51.7% (n= 461) received BS antibiotics and 48.3% (n = 430) received NS antibiotics. Overall antibiotic duration was longer in the BS group than in the NS group (6 vs 4 d, p = 0.01); however, there was no difference in rates of SSI (0.9% vs 0.5%, p = 0.7) or 30-day readmission for SSI (1.1% vs 1.2%, p = 1.0). Hospital length of stay was significantly longer in the BS group (p < 0.001) as were rates of AKI (5% vs 1.4%, p = 0.001). On multivariable regression, BS antibiotic use was a risk factor for AKI (adjusted odds ratio 2.8, 95% CI 1.16 to 7.82, p = 0.02).

CONCLUSION

The incidence of SSI and 30-day readmission for SSI was similar between antibiotic groups. However, BS antibiotic use was associated with a longer hospitalization and greater likelihood of AKI.

Impact of Cluster Nursing on Nursing on VAS Score and Urinary Function of Patients after Percutaneous Nephrolithotomy with Pneumatic Lithotripsy (PCNL)

Objective. To explore the effects of cluster nursing on VAS score and urinary system function of patients after percutaneous nephrolithotomy with pneumatic lithotripsy (PCNL). Methods. November 2019-January 2019, 114 patients with PCNL who received treatment in our hospital were selected and randomly divided into two groups: the control group and the study group. The study group received cluster nursing, and the control group received routine nursing. Compare the Barthel index (BI), between two groups, SAS score, complications rate, surgical outcomes, pain scores, quality of life scores, knowledge awareness rate, and satisfaction rate were compared. Results. There were no significant variations in Bi and SAS scores before the nursing ( $P>0.05$ ). The BI ratings were clearly higher after nursing, whereas the SAS and pain levels were considerably lower, however, the research group altered more dramatically ( $P0.05$ ). The study group’s incidence of complications was lower ( $P0.05$ ) than the control group’s; the study group’s hospitalization cost was lower, and the hospitalization and lower bed activity were shorter ( $P0.05$ ); after the nursing, the organised quality score was significantly higher in both groups, but the research group changed more dramatically ( $P0.05$ ). Compared with the control group, the knowledge of the research team was higher ( $P<0.05$ ); after the nursing, both group satisfaction scores were obviously high, but the study group changes more significantly ( $P<0.05$ ). Conclusion. After PCNL treatment, the patient receives cluster therapy, improving the patient’s anxiety, reducing the degree of pain, and improving the quality of life in patients, and the patient satisfaction is high. Therefore, cluster nursing is worthy of extensive application in the postoperative care of patients with PCNL.