Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, Yokohama, Kanagawa, Japan.
PLoS One. 2020 Oct 14;15(10):e0240490. doi: 10.1371/journal.pone.0240490. eCollection 2020.
Surgical site infection is a major perioperative issue. The morbidity of surgical site infection is high in major digestive surgery, such as pancreaticoduodenectomy. The comprehensive risk factors, including anesthetic factors, for surgical site infection in pancreaticoduodenectomy are unknown. The aim of this study was to investigate the perioperative and anesthetic risk factors of surgical site infection in pancreaticoduodenectomy.
This was a retrospective cohort study conducted in a single tertiary care center. A total of 326 consecutive patients who underwent pancreaticoduodenectomy between January 2009 and March 2018 were evaluated. Patients who underwent resection of other organs were excluded. The primary outcome was the incidence of surgical site infection, based on a Clavien-Dindo classification of grade 2 or higher. Multivariable logistic regression analysis was performed to investigate the association between surgical site infection and perioperative and anesthetic factors.
Of the 326 patients, 116 (35.6%) were women. The median age was 70 years (interquartile range; 64-75). The median duration of surgery was 10.9 hours (interquartile range; 9.5-12.4). Surgical site infection occurred in 60 patients (18.4%). The multivariable analysis revealed that the use of desflurane as a maintenance anesthetic was associated with a significantly lower risk of surgical site infection than sevoflurane (odds ratio, 0.503; 95% confidence interval [CI], 0.260-0.973). In contrast, the duration of surgery (odds ratio, 1.162; 95% CI, 1.017-1.328), cerebrovascular disease (odds ratio, 3.544; 95% CI, 1.326-9.469), and ischemic heart disease (odds ratio, 10.839; 95% CI, 1.887-62.249) were identified as significant risk factors of surgical site infection.
Desflurane may be better than sevoflurane in preventing surgical site infection in pancreaticoduodenectomy. Cerebrovascular disease and ischemic heart disease are potential newly-identified risk factors of surgical site infection in pancreaticoduodenectomy.
手术部位感染是围手术期的主要问题。在胰十二指肠切除术等主要消化道手术中，手术部位感染的发病率较高。胰十二指肠切除术后手术部位感染的综合危险因素，包括麻醉因素，尚不清楚。本研究旨在探讨胰十二指肠切除术中围手术期和麻醉相关的手术部位感染危险因素。
这是一项在单中心三级医疗机构进行的回顾性队列研究。共评估了 2009 年 1 月至 2018 年 3 月期间接受胰十二指肠切除术的 326 例连续患者。排除了同时切除其他器官的患者。主要结局是基于 Clavien-Dindo 分级 2 级或更高的手术部位感染发生率。采用多变量逻辑回归分析探讨手术部位感染与围手术期和麻醉相关因素的关系。
326 例患者中，116 例（35.6%）为女性。中位年龄为 70 岁（四分位距；64-75）。中位手术时间为 10.9 小时（四分位距；9.5-12.4）。60 例患者（18.4%）发生手术部位感染。多变量分析显示，与七氟醚相比，地氟醚作为维持麻醉与手术部位感染风险显著降低相关（比值比，0.503；95%置信区间[CI]，0.260-0.973）。相比之下，手术时间（比值比，1.162；95%CI，1.017-1.328）、脑血管病（比值比，3.544；95%CI，1.326-9.469）和缺血性心脏病（比值比，10.839；95%CI，1.887-62.249）被确定为手术部位感染的显著危险因素。
与七氟醚相比，地氟醚可能更有利于预防胰十二指肠切除术后手术部位感染。脑血管病和缺血性心脏病是胰十二指肠切除术后手术部位感染的潜在新危险因素。
