Mentor Keno, Ratnayake Bathiya, Akter Nasreen, Alessandri Giorgio, Sen Gourab, French Jeremy J, Manas Derek M, Hammond John S, Pandanaboyana Sanjay
HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
World J Surg. 2020 Dec;44(12):4221-4230. doi: 10.1007/s00268-020-05741-6. Epub 2020 Aug 18.
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.
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.
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).
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.
肝胰胆（HPB）手术后手术部位感染（SSI）的危险因素尚不明确。本荟萃分析旨在量化胰腺和肝脏切除术后的SSI发生率及SSI的危险因素。
使用PRISMA框架对PUBMED、MEDLINE和EMBASE数据库进行系统检索。主要结局指标是汇总的SSI发生率。次要结局指标是确定SSI的危险因素。
胰腺和肝脏切除术后的总体SSI发生率分别为25.1%和10.4%（p<0.001）。32%的胰十二指肠切除术发生了SSI，而远端胰腺切除术后为23%（p<0.001）。胰腺组的切口SSI发生率为9%，器官/腔隙SSI发生率为16.5%。肝脏手术期间的胆道切除术是SSI的一个危险因素（25.0%对15.7%，p=0.002）。肝脏切除术后，切口SSI发生率为7.6% , 器官腔隙SSI发生率为10.2%。胰腺特异性SSI危险因素为术前胆道引流（p<0.001）、化疗（p<0.001）和放疗（p=0.007）。肝脏特异性SSI危险因素为吸烟（p=0.046）、低白蛋白（p<0.001）和大量失血（p<0.001）。胰瘘患者的器官/腔隙SSI发生率为47.7%，无胰瘘患者为7.3%（p<0.001）。胆漏患者的器官/腔隙SSI发生率为43%，无胆漏患者为10%（p<0.001）。
胰腺和肝脏切除术后SSI的危险因素各不相同，胰腺切除术后SSI发生率更高。与远端胰腺切除术相比，胰十二指肠切除术发生SSI的风险增加。同样，肝脏手术期间的胆道切除术会增加SSI发生率。
