Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, Chicago, Illinois.
Creticos Cancer Center at Advocate Illinois Masonic Medical Center, Chicago, Illinois.
Ann Surg. 2022 Jun 1;275(6):1175-1183. doi: 10.1097/SLA.0000000000004216. Epub 2020 Jul 24.
Compare the effectiveness of 1st-3rd generation cephalosporins (1st-3rdCE) to broad-spectrum antibiotics in decreasing surgical site infections (SSI) after pancreatectomy.
SSI is one of the most common complications after pancreatic surgery. Various antibiotic regimens are utilized nationwide with no clear guidelines for pancreatectomy. As we await results of a recently initiated prospective trial, this study retrospectively evaluates over 15,000 patients using the same administrative data abstraction tools as in the trial.
All relevant clinical variables were collected from the 2016-2018 targeted-pancreatectomy database from the American College of Surgeon National Surgical Quality Improvement Program. Preoperative antibiotics were initially collected as first-generation cephalosporin, second or third-generation cephalosporin, and broad-spectrum antibiotics (Broad-abx).
Of the 15,182 patients who completed a pancreatic surgery between 2016 and 2018, 6114 (40%) received a first-generation cephalosporin, 4097 (27%) received a second or third-generation cephalosporin, and 4971 (33%) received Broad-abx. On multivariate analysis, Broad-abx was associated with a decrease in all-type SSI compared to 1st-3rdCE (odds ratio = 0.73-0.77, P < 0.001) after open pancreaticoduodenectomy (PD). There was no difference in SSI between antibiotic-types after distal pancreatectomy. Subgroup multivariate analysis of open PD revealed decrease in all-type SSI with Broad-abx amongst patients with jaundice and/or biliary stent only, regardless of wound protector use (odds ratio = 0.69-0.70, P < 0.001). Propensity score matching of open PD patients with jaundice and/or biliary stent confirmed a decrease in all-type SSI (19% vs 24%, P = 0.001), and organ-space SSI (12% vs 16%, P < 0.001).
Broad-abx are associated with decreased SSI after open PD and may be preferred specifically for patients with preoperative biliary stent and/ or jaundice.
比较第一代至第三代头孢菌素（1 至 3 代 CE）与广谱抗生素在降低胰腺切除术后手术部位感染（SSI）方面的效果。
SSI 是胰腺手术后最常见的并发症之一。全国各地使用了各种抗生素方案，但没有针对胰腺切除术的明确指南。在等待最近启动的前瞻性试验结果的同时，本研究使用与试验相同的行政数据提取工具回顾性评估了超过 15000 名患者。
从美国外科医师学院国家外科质量改进计划 2016-2018 年的靶向胰腺切除术数据库中收集所有相关临床变量。术前抗生素最初被收集为第一代头孢菌素、第二代或第三代头孢菌素和广谱抗生素（广谱抗生素）。
在 2016 年至 2018 年间完成胰腺手术的 15182 名患者中，6114 名（40%）接受了第一代头孢菌素，4097 名（27%）接受了第二代或第三代头孢菌素，4971 名（33%）接受了广谱抗生素。多变量分析显示，与第一代至第三代 CE 相比，广谱抗生素与开腹胰十二指肠切除术（PD）后所有类型 SSI 的减少相关（比值比=0.73-0.77，P<0.001）。在胰体尾切除术（DP）后，抗生素类型之间的 SSI 无差异。开腹 PD 的亚组多变量分析显示，在仅存在黄疸和/或胆道支架的患者中，广谱抗生素可降低所有类型的 SSI（比值比=0.69-0.70，P<0.001），无论是否使用伤口保护器。在开腹 PD 患者中，具有黄疸和/或胆道支架的患者经倾向评分匹配证实所有类型 SSI 减少（19%比 24%，P=0.001），且器官间隙 SSI 减少（12%比 16%，P<0.001）。
广谱抗生素与开腹 PD 后 SSI 的减少相关，对于术前存在胆道支架和/或黄疸的患者可能是首选。
