Division of Surgical Oncology, Department of Surgery, University of Louisville, KY.
Department of Bioinformatics and Biostatistics, University of Louisville, KY.
Surgery. 2023 May;173(5):1231-1239. doi: 10.1016/j.surg.2022.12.012. Epub 2023 Jan 25.
The aim of this meta-analysis and systematic review was to evaluate the association between intraoperative bile cultures and postoperative complications of patients undergoing pancreaticoduodenectomy.
A detailed literature search was performed from January 2015 to July 2022 in PubMed, Web of Science, Google Scholar, and EMBASE for related research publications. The data were extracted, screened, and graded independently. An analysis of pooled data was performed, and a risk ratio with corresponding confidence intervals was calculated and summarized.
A total of 8 articles were included with 1,778 pancreaticoduodenectomy patients who had an intraoperative bile culture performed. A systematic review demonstrated that some of the most common organisms isolated in a positive intraoperative bile culture were Enterococcus species, Klebsiella species, and E. coli. Four studies also showed that specific microorganisms were associated with specific postoperative complications (surgical site infection and intra-abdominal abscess). The postoperative complications that were evaluated for an association with a positive intraoperative bile culture were surgical site infections (risk ratio = 2.33, 95% confidence interval [1.47-3.69], P < .01), delayed gastric emptying (risk ratio = 1.23, 95% confidence interval [0.63-2.38], P = n.s.), 90-day mortality (risk ratio = 0.68, 95% confidence interval [0.01-52.76], P = n.s.), postoperative pancreatic hemorrhage (risk ratio = 1.70, 95% confidence interval [0.33-8.74], P = n.s.), intra-abdominal abscess (risk ratio = 1.70, 95% confidence interval [0.38-7.56], P = n.s.), and postoperative pancreatic fistula (risk ratio = 0.97, 95% confidence interval [0.72-1.32], P = n.s.).
The cumulative data suggest that a positive intraoperative bile culture has no association with predicting the postoperative complications of delayed gastric emptying, 90-day mortality, postoperative pancreatic hemorrhage, intra-abdominal abscess, or postoperative pancreatic fistula. However, the data also suggest that a positive intraoperative bile culture was associated with a patient developing a surgical site infection.
本荟萃分析和系统评价旨在评估行胰十二指肠切除术患者术中胆汁培养与术后并发症之间的关系。
从 2015 年 1 月至 2022 年 7 月，我们在 PubMed、Web of Science、Google Scholar 和 EMBASE 中对相关研究出版物进行了详细的文献检索。我们独立提取、筛选和分级数据。对汇总数据进行分析，并计算和总结风险比及其置信区间。
共有 8 项研究纳入 1778 例行胰十二指肠切除术且术中行胆汁培养的患者。系统评价表明，阳性术中胆汁培养中最常见的分离菌为肠球菌属、克雷伯菌属和大肠杆菌。四项研究还表明，特定微生物与特定术后并发症（手术部位感染和腹腔脓肿）相关。评估与阳性术中胆汁培养相关的术后并发症包括手术部位感染（风险比=2.33，95%置信区间[1.47-3.69]，P<.01）、胃排空延迟（风险比=1.23，95%置信区间[0.63-2.38]，P=无统计学意义）、90 天死亡率（风险比=0.68，95%置信区间[0.01-52.76]，P=无统计学意义）、术后胰腺出血（风险比=1.70，95%置信区间[0.33-8.74]，P=无统计学意义）、腹腔脓肿（风险比=1.70，95%置信区间[0.38-7.56]，P=无统计学意义）和术后胰腺瘘（风险比=0.97，95%置信区间[0.72-1.32]，P=无统计学意义）。
累积数据表明，阳性术中胆汁培养与预测胃排空延迟、90 天死亡率、术后胰腺出血、腹腔脓肿或术后胰腺瘘等术后并发症无关。然而，数据还表明，阳性术中胆汁培养与患者发生手术部位感染相关。
