Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, Italy.
Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, Italy.
Surgery. 2022 Sep;172(3):813-820. doi: 10.1016/j.surg.2022.04.028. Epub 2022 May 24.
The aim of this study was to analyze the risk factors for surgical infectious complications and the outcomes of patients undergoing surgery for perihilar cholangiocarcinoma according to the microbiological examinations.
Patients who underwent surgery for perihilar cholangiocarcinoma in the last decade were enrolled, and all clinical and microbiological data were collected from a retrospective monocentric database. Univariate and multivariate analyses were performed distinguishing patients who developed at least 1 surgical infectious complication (surgical site infections, acute bacterial cholangitis, bacteremia).
A total of 98 patients were included. Among patients who developed surgical infectious complications (51%), many preoperative characteristics were significantly more frequent: American Society of Anesthesiologists score ≥3 (P = .026), neutrophil-to-lymphocyte ratio ≥3.4 (P = .001), endoscopic sphincterotomy (P = .032), ≥2 biliary drainage procedures (P = .013), acute cholangitis (P = .012), multidrug resistant (P = .009), and ≥3 microorganisms' detection (P = .042); whereas during the postoperative period, surgical infectious complications were associated to increased incidence of intensive care unit readmission (P = .031), major complications (P < .001), posthepatectomy liver failure (P = .005), ascites (P = .008), biliary leakage (P = .008), 90-day readmission (P = .003), and prolonged length of hospital stay (P < .001). At the multivariate analysis 3 independent preoperative risk factors for surgical infectious complications were identified: neutrophil-to-lymphocyte ratio ≥3.4 (P = .004), endoscopic sphincterotomy (P = .009), and acute cholangitis (P = .013). The presence of multidrug-resistance in the perioperative biliary cultures was related to postoperative multidrug-resistant species from all cultures (P < .001) and organ/space and incisional-surgical site infections (P ≤ .044).
Infective complications after surgery for perihilar cholangiocarcinoma worsen the short-term outcomes. A careful microbiological surveillance should be carried out in all cases to prevent and promptly treat surgical infectious complications.
本研究旨在分析根据微生物检查结果，行肝门部胆管癌切除术患者发生手术感染性并发症的危险因素和结局。
回顾性分析过去十年间在我院行肝门部胆管癌切除术的患者的临床和微生物学数据。采用单因素和多因素分析方法，比较发生至少 1 种手术感染性并发症（手术部位感染、急性细菌性胆管炎、菌血症）与未发生手术感染性并发症患者的临床特征。
共纳入 98 例患者。发生手术感染性并发症的患者（51%）中，许多术前特征更为常见：美国麻醉医师协会（ASA）评分≥3（P=0.026）、中性粒细胞与淋巴细胞比值≥3.4（P=0.001）、内镜下括约肌切开术（P=0.032）、≥2 次胆道引流术（P=0.013）、急性胆管炎（P=0.012）、多重耐药菌（P=0.009）和≥3 种微生物检测（P=0.042）；术后，发生手术感染性并发症的患者 ICU 再入院率（P=0.031）、主要并发症（P<0.001）、肝切除术后肝功能衰竭（P=0.005）、腹水（P=0.008）、胆漏（P=0.008）、90 天再入院率（P=0.003）和住院时间延长（P<0.001）的发生率更高。多因素分析显示，术前 3 个独立的危险因素为中性粒细胞与淋巴细胞比值≥3.4（P=0.004）、内镜下括约肌切开术（P=0.009）和急性胆管炎（P=0.013）。术中胆道培养为多重耐药菌与术后所有培养物的多重耐药菌（P<0.001）和器官/腔隙及切口手术部位感染（P≤0.044）相关。
肝门部胆管癌切除术后感染性并发症会加重短期结局。应仔细进行微生物监测，以预防和及时治疗手术感染性并发症。
