GI Oncology Program, Moffitt Cancer Center, Tampa, Florida.
GI Oncology Program, Moffitt Cancer Center, Tampa, Florida.
J Surg Res. 2022 Nov;279:722-732. doi: 10.1016/j.jss.2022.06.028. Epub 2022 Aug 4.
We hypothesized that first-generation cephalosporins (G1CEP) provide adequate antimicrobial coverage for pancreaticoduodenectomy (PD) when no biliary stent is present but might be inferior to second-generation cephalosporins or broad-spectrum antibiotics (G2CEP/BS) in decreasing surgical-site infection (SSI) rates when a biliary stent is present.
The National Surgical Quality Improvement Program 2014-2019 was used to select patients who underwent elective open PD. We divided the population into no-stent versus stent groups based on the status of biliary drainage and then divided each group into G1CEP versus G2CEP/BS subgroups based on the choice of perioperative antibiotics. We matched the subgroups per a propensity score match and analyzed postoperative outcomes.
Six thousand two hundred forty five cases of 39,779 were selected; 2821 in the no-stent (45.2%) versus 3424 (54.8%) in the stent group. G1CEP were the antibiotics of choice in 2653 (42.5%) versus G2CEP/BS in 3592 (57.5%) cases. In the no-stent group, we matched 1129 patients between G1CEP and G2CEP/BS. There was no difference in SSI-specific complications (20.3% versus 21.0%; P = 0.677), general infectious complications (25.7% versus 26.9%; P = 0.503), PD-specific complications, overall morbidity, length of stay, or mortality. In the stent group, we matched 1244 pairs. G2CEP/BS had fewer SSI-specific complications (19.9% versus 26.6%; P < 0.001), collections requiring drainage (9.6% versus 12.9%; P = 0.011), and general infectious complications (28.5% versus 34.1%; P = 0.002) but no difference in overall morbidity, mortality, length of stay, and readmission rates.
G2CEP/BS are associated with reduced rates of SSI-specific and infectious complications in stented patients undergoing open elective PD. In patients without prior biliary drainage, G1CEP seems to provide adequate antimicrobial coverage.
我们假设第一代头孢菌素（G1CEP）在没有胆管支架的情况下可以为胰十二指肠切除术（PD）提供足够的抗菌覆盖，但在有胆管支架的情况下，与第二代头孢菌素或广谱抗生素（G2CEP/BS）相比，降低手术部位感染（SSI）的发生率可能较差。
使用国家手术质量改进计划 2014-2019 年的数据选择接受择期开放 PD 的患者。我们根据胆管引流的情况将人群分为无支架组和支架组，然后根据围手术期抗生素的选择将每组分为 G1CEP 组和 G2CEP/BS 组。我们根据倾向评分匹配将亚组进行匹配，并分析术后结果。
在 39779 例中，有 6245 例符合条件；无支架组 2821 例（45.2%），支架组 3424 例（54.8%）。G1CEP 是 2653 例（42.5%）抗生素的首选，G2CEP/BS 是 3592 例（57.5%）抗生素的首选。在无支架组中，我们在 G1CEP 和 G2CEP/BS 之间匹配了 1129 例患者。两组在 SSI 特异性并发症（20.3%对 21.0%；P=0.677）、一般感染性并发症（25.7%对 26.9%；P=0.503）、PD 特异性并发症、总发病率、住院时间或死亡率方面均无差异。在支架组中，我们匹配了 1244 对患者。G2CEP/BS 的 SSI 特异性并发症（19.9%对 26.6%；P<0.001）、需要引流的积液（9.6%对 12.9%；P=0.011）和一般感染性并发症（28.5%对 34.1%；P=0.002）较少，但总发病率、死亡率、住院时间和再入院率无差异。
在接受择期开放 PD 的支架患者中，G2CEP/BS 与 SSI 特异性和感染性并发症发生率降低有关。在没有先前胆管引流的患者中，G1CEP 似乎可以提供足够的抗菌覆盖。
