Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Cancer Center, Philadelphia, Pennsylvania 19107, USA.
J Surg Res. 2012 May 15;174(2):215-21. doi: 10.1016/j.jss.2011.09.028. Epub 2011 Oct 11.
Pancreaticoduodenectomy (PD) is a complex surgical procedure with a historically high morbidity rate. The goal of this study was to determine if the implementation of a 12-measure perioperative surgical care bundle (SCB) was successful in reducing infectious and other complications in patients undergoing PD compared with a routine preoperative preparation group (RPP).
In this retrospective cohort study utilizing the HPB surgery database at the Thomas Jefferson University, we analyzed clinical data from 233 consecutive PDs from October 2005 to May 2008 on patients who underwent RPP, and compared them with 233 consecutive PDs from May 2008 to May 2010 following the implementation of the SCB. The SCB was the product of multidisciplinary discussion and extensive literature review.
The RPP group and the SCB group had similar demographic characteristics. The overall rate of postoperative morbidity was similar between groups (42.1% versus 37.8%). However, wound infections were significantly lower in the SCB group (15.0% versus 7.7%, P = 0.01).The rates of other common complications, as well as postoperative hospital length of stay, readmissions, and 30-d postoperative mortality were similar between groups.
The implementation of a SCB was followed by a significant decline in wound infection in patients undergoing PD.
胰十二指肠切除术（PD）是一种复杂的手术程序，历史上发病率较高。本研究的目的是确定在与常规术前准备组（RPP）相比，实施 12 项围手术期外科护理包（SCB）是否成功降低了接受 PD 的患者的感染和其他并发症。
在这项利用托马斯杰斐逊大学的 HPB 手术数据库进行的回顾性队列研究中，我们分析了 2005 年 10 月至 2008 年 5 月期间接受 RPP 的 233 例连续 PD 的临床数据，并将其与 2008 年 5 月至 2010 年 5 月期间实施 SCB 后接受的 233 例连续 PD 进行比较。SCB 是多学科讨论和广泛文献回顾的产物。
RPP 组和 SCB 组的人口统计学特征相似。两组术后发病率相似（42.1%对 37.8%）。然而，SCB 组的伤口感染明显较低（15.0%对 7.7%，P=0.01）。SCB 组的其他常见并发症发生率以及术后住院时间、再入院和 30 天术后死亡率与 RPP 组相似。
实施 SCB 后，接受 PD 的患者的伤口感染率显著下降。
