Hasjim Bima J, Grigorian Areg, Jutric Zeljka, Wolf Ronald F, Yamamoto Maki, Imagawa David K, Nahmias Jeffry
Department of Surgery, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA.
University of Southern California, Department of Surgery, Los Angeles, California, USA.
Surg Infect (Larchmt). 2022 Feb;23(1):22-28. doi: 10.1089/sur.2021.149. Epub 2021 Sep 7.
Routine intra-operative abdominal drain placement (IADP) is not beneficial for uncomplicated cholecystectomies though outcomes in gallbladder cancer surgery is unclear. This retrospective study hypothesized that patients with IADP (+IADP) for gallbladder cancer surgery have a higher risk of post-operative infectious complications (PIC) compared with patients without IADP (-IADP). The 2014-2017 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for +IADP and -IADP patients who had gallbladder cancer surgery. Post-operative infectious complications were defined as septic shock, organ/space infection (OSI), or percutaneous drainage. Multivariable analyses were performed to analyze the associated risk of PIC. Of 385 patients, 237 (61.6%) were +IADP. The +IADP patients had higher rates of post-operative bile leak, OSI, re-admission, and increased length of stay (p < 0.05). The +IADP patients were not associated with increased risk of PIC (p > 0.05). Bile leak (odds ratio [OR], 10.61; p < 0.001), peri-operative blood transfusion (OR, 3.77; p = 0.003), biliary reconstruction (OR, 2.88; p = 0.018), and pre-operative biliary stent placement (OR, 3.02; p = 0.018) were the strongest associated risk factors of PIC. Patients with drains in place at or longer than 30 days post-operatively had an increased associated risk compared with patients who did not (OR, 6.88; 95% confidence interval [CI], 2.16-21.86; p < 0.001). More than 60% of gallbladder cancer surgeries included IADP and was not associated with an increased risk of PIC. Intra-operative abdominal drain placement was not associated with an increased risk of PIC, unless drains were left in place for 30 days or longer. Increased risk of PIC was associated with bile leak, peri-operative blood transfusion, pre-operative biliary stent placement, and biliary reconstruction.
常规术中放置腹腔引流管（IADP）对单纯性胆囊切除术并无益处，不过其对胆囊癌手术预后的影响尚不清楚。这项回顾性研究假设，与未放置IADP（-IADP）的患者相比，接受胆囊癌手术且放置IADP（+IADP）的患者术后发生感染性并发症（PIC）的风险更高。我们查询了2014 - 2017年美国外科医师学会国家外科质量改进计划（ACS - NSQIP）数据库中接受胆囊癌手术的+IADP和 -IADP患者。术后感染性并发症定义为感染性休克、器官/腔隙感染（OSI）或经皮引流。进行多变量分析以分析PIC的相关风险。在385例患者中，237例（61.6%）为+IADP。+IADP患者术后胆漏、OSI、再次入院率及住院时间延长的发生率更高（p < 0.05）。+IADP患者与PIC风险增加无关（p > 0.05）。胆漏（比值比[OR]，10.61；p < 0.001）、围手术期输血（OR，3.77；p = 0.003）、胆管重建（OR，2.88；p = 0.018）以及术前放置胆管支架（OR，3.02；p = 0.018）是PIC最强的相关危险因素。术后放置引流管30天及以上的患者相比未放置引流管的患者，相关风险增加（OR，6.88；95%置信区间[CI]，2.16 - 21.86；p < 0.001）。超过60%的胆囊癌手术包括IADP，且与PIC风险增加无关。术中放置腹腔引流管与PIC风险增加无关，除非引流管放置30天或更长时间。PIC风险增加与胆漏、围手术期输血、术前放置胆管支架及胆管重建有关。
