Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH.
Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH.
Surgery. 2024 Feb;175(2):477-483. doi: 10.1016/j.surg.2023.09.049. Epub 2023 Nov 7.
Clinically relevant postoperative pancreatic fistula remains a common complication after pancreatoduodenectomy. The fistula risk score is a validated tool to predict the risk of clinically relevant postoperative pancreatic fistula. To mitigate complications, we have implemented an extended antibiotic pathway for patients at increased risk of clinically relevant postoperative pancreatic fistula (fistula risk score ≥3). We report outcomes after pancreatoduodenectomy in patients at increased risk for clinically relevant postoperative pancreatic fistula who received extended antibiotic therapy compared to those who received standard perioperative antibiotics (single dose before incision).
Single-institution analysis of 87 patients who underwent elective pancreatoduodenectomy (2018-2022) with soft gland texture and fistula risk score ≥3 and were treated with (n = 34) or without (n = 53) 10 days of broad-spectrum antibiotics (piperacillin/tazobactam converted to amoxicillin/clavulanic acid at discharge) after surgery. Associations between extended antibiotics and postoperative outcomes were analyzed.
Baseline clinicodemographic factors were similar between cohorts. Patients who received extended antibiotics had shorter index days (6 vs 8 days, P = .004) and 90-day composite length of stay (8.5 vs 12 days, P = .018). Patients who received extended antibiotics had lower rates of clinically relevant postoperative pancreatic fistula (11.8% vs 37.7%; odds ratio = 0.17, 95% confidence interval: 0.04-0.68), wound infections (8.8% vs 30.2%; odds ratio = 0.08, 95% confidence interval: 0.01-0.50), organ space infections (14.7% vs 43.4%; odds ratio = 0.15, 95% confidence interval: 0.04-0.52), and image-guided drain placement (8.8% vs 34.0%; odds ratio = 0.15, 95% confidence interval: 0.04-0.62). There were no Clostridium difficile infections in the extended antibiotic group.
Extended antibiotic therapy is associated with a lower rate of clinically relevant postoperative pancreatic fistula and associated complications after pancreatoduodenectomy in patients with a fistula risk score ≥3. These results form the basis of a randomized controlled trial (NCT05753735).
临床相关的术后胰瘘仍然是胰十二指肠切除术后的常见并发症。胰瘘风险评分是预测临床相关术后胰瘘风险的有效工具。为了减轻并发症，我们对具有较高临床相关术后胰瘘风险（胰瘘风险评分≥3）的患者实施了延长抗生素治疗路径。我们报告了在胰十二指肠切除术后接受延长抗生素治疗的高风险患者的结果，与接受标准围手术期抗生素（切口前单次剂量）的患者相比。
对 2018 年至 2022 年期间因软腺体质地和胰瘘风险评分≥3 而行择期胰十二指肠切除术的 87 例患者进行单中心分析，这些患者接受了（n=34）或未接受（n=53）10 天广谱抗生素（术后出院时转换为哌拉西林/他唑巴坦为阿莫西林/克拉维酸）治疗。分析了延长抗生素与术后结果之间的关系。
两组患者的基线临床和人口统计学因素相似。接受延长抗生素治疗的患者住院时间较短（6 天与 8 天，P=0.004）和 90 天复合住院时间（8.5 天与 12 天，P=0.018）。接受延长抗生素治疗的患者术后胰瘘（11.8%比 37.7%；比值比=0.17，95%置信区间：0.04-0.68）、伤口感染（8.8%比 30.2%；比值比=0.08，95%置信区间：0.01-0.50）、器官间隙感染（14.7%比 43.4%；比值比=0.15，95%置信区间：0.04-0.52）和影像引导引流放置（8.8%比 34.0%；比值比=0.15，95%置信区间：0.04-0.62）的发生率较低。延长抗生素组无艰难梭菌感染。
在胰瘘风险评分≥3 的患者中，胰十二指肠切除术后使用延长抗生素治疗与临床相关胰瘘和相关并发症的发生率较低相关。这些结果为随机对照试验（NCT05753735）奠定了基础。
