Feng Wendy, Irfan Ahmer, Fleece Molly, Dudeja Vikas, Reddy Sushanth, Hashmi Salila, Rose J Bart, Lee Rachael A
University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States.
Division of Surgical Oncology, University of Alabama at Birmingham, Birmingham, Alabama, United States.
Antimicrob Steward Healthc Epidemiol. 2023 Mar 1;3(1):e36. doi: 10.1017/ash.2022.377. eCollection 2023.
The purpose of this study is to understand the role of risk factors and postoperative complications seen in patients undergoing Whipple procedures in the development of surgical site infections. Our secondary goal was to evaluate whether microbial patterns differed between preoperative antibiotic classes, offering insight into the effectiveness of current practices while promoting antibiotic stewardship.
We performed a retrospective cohort study comparing patients with and without SSIs.
This study was conducted at a tertiary-care center in the southeastern United States.
Patients who underwent a Whipple procedure between 2012 and 2021 were acquired from the National Surgical Quality Improvement Program (NSQIP) database.
Patients with a bleeding disorder reported higher SSI rates ( = .04), whereas patients with a biliary stent reported lower surgical site infection (SSI) rates ( = .02) Those with postoperative complications had higher SSI rates, including delayed gastric emptying ( < .001) and pancreatic fistula ( < .001). Patients with longer operative times were 1.002 times more likely to develop SSIs (adjusted odds ratio [aOR], 1.002; 95% confidence interval [CI], 1.001-1.004; = .006) whereas surgical indications for malignancy correlated with decreased SSIs risk (aOR, 0.578; 95% CI, 0.386-866) when adjusting for body mass index, surgical indication, and duration of surgical procedure.
Optimizing preoperative management of modifiable risk factors for patients undergoing pancreatoduodenectomies and decreasing operative times may reduce SSI rates and patient and hospital burden. Further research is needed to understand whether stent placement reduces SSI risk in pancreatoduodenectomy.
本研究旨在了解接受惠普尔手术的患者中危险因素和术后并发症在手术部位感染发生过程中的作用。我们的次要目标是评估术前使用不同种类抗生素时微生物模式是否存在差异，以便深入了解当前做法的有效性，同时促进抗生素管理。
我们进行了一项回顾性队列研究，比较有手术部位感染（SSI）和无SSI的患者。
本研究在美国东南部的一家三级医疗中心进行。
从国家外科质量改进计划（NSQIP）数据库中获取2012年至2021年间接受惠普尔手术的患者。
有出血性疾病的患者报告的SSI发生率较高（P = 0.04），而有胆管支架的患者手术部位感染（SSI）发生率较低（P = 0.02）。有术后并发症的患者SSI发生率较高，包括胃排空延迟（P < 0.001）和胰瘘（P < 0.001）。手术时间较长的患者发生SSI的可能性高1.002倍（调整后的优势比[aOR]，1.002；95%置信区间[CI]，1.001 - 1.004；P = 0.006），而在调整体重指数、手术指征和手术持续时间后，恶性肿瘤的手术指征与SSI风险降低相关（aOR，0.578；95% CI，0.386 - 0.866）。
优化接受胰十二指肠切除术患者的可改变危险因素的术前管理并缩短手术时间，可能会降低SSI发生率以及患者和医院的负担。需要进一步研究以了解支架置入是否能降低胰十二指肠切除术中的SSI风险。
