Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Department of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Support Care Cancer. 2021 Feb;29(2):653-659. doi: 10.1007/s00520-020-05525-7. Epub 2020 May 18.
This study retrospectively investigated relationships among risk factors and post-hepatectomy surgical site infection (SSI) and other complications in patients who underwent hepatectomy for hepatocellular carcinoma (HCC).
We included 334 patients who underwent hepatectomies for liver cancers between January 2011 and December 2015 in this study. We evaluated risk factors for SSI and other post-hepatectomy complication, including demographic factors, preoperative factors, and preoperative intervention including oral management, perioperative factors, and length of hospital stay, with univariate and multivariate analyses. The oral management intervention included self-care instructions, extraction of infected teeth, removal of dental plaques and calculus (scaling), professional mechanical teeth cleaning, removal of tongue coating, and cleaning of dentures. SSI was defined in accordance with the guideline issued by the Centers for Disease Control and Prevention; it included purulent discharge from any incision or organ space within 30 days postoperatively, with or without microbiological evidence. Complications of grade II or greater, according to the Clavien-Dindo classification, were regarded as postoperative complications.
We found bacterial infection of ascites (Odds ratio (OR) = 13.72), lack of preoperative oral management intervention (OR = 10.17), and severe liver fibrosis (OR = 2.76) to be associated with SSI and severe liver fibrosis (OR = 2.28), hypoalbuminemia (OR = 2.02), blood transfusion (OR = 1.86), and longer operation time (OR = 1.80) to be associated with postoperative complications.
Preoperative oral management may reduce the risk of SSI in patients with HCC who undergo hepatectomy.
本研究回顾性分析了行肝癌切除术患者的手术部位感染（SSI）及其他术后并发症的危险因素。
本研究纳入了 2011 年 1 月至 2015 年 12 月期间因肝癌行肝切除术的 334 例患者。我们通过单因素和多因素分析评估了 SSI 及其他术后并发症的危险因素，包括人口统计学因素、术前因素、术前干预（包括口腔管理）、围手术期因素和住院时间。口腔管理干预包括自我护理指导、感染牙齿拔除、牙斑和牙石（洁治）去除、专业机械洁牙、舌苔去除和义齿清洁。SSI 定义为术后 30 天内任何切口或体腔出现脓性分泌物，无论是否有微生物学证据。根据 Clavien-Dindo 分级，将 II 级或更高级别的并发症视为术后并发症。
我们发现腹水细菌感染（优势比（OR）=13.72）、缺乏术前口腔管理干预（OR=10.17）和严重肝纤维化（OR=2.76）与 SSI 相关，严重肝纤维化（OR=2.28）、低白蛋白血症（OR=2.02）、输血（OR=1.86）和手术时间延长（OR=1.80）与术后并发症相关。
术前口腔管理可能降低行肝癌切除术患者的 SSI 风险。
