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Zuo JH, Che XY, Tan BB, Jiang Y, Bai J, Li XL, Yang YS, Pang SJ, Liu XC, Fan HN, Zhang CC, Wang JJ, Zhang YQ, Dai HS, Chen ZY, Gan L, Liu ZP. Association between Pre-operative Body Mass Index and Surgical Infection in Perihilar Cholangiocarcinoma Patients Treated with Curative Resection: A Multi-center Study. Surg Infect (Larchmt) 2024; 25:444-451. [PMID: 38957995 DOI: 10.1089/sur.2023.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Background: The objective of this study was to investigate the association between pre-operative body mass index (BMI) and surgical infection in perihilar cholangiocarcinoma (pCCA) patients treated with curative resection. Methods: Consecutive pCCA patients were enrolled from four tertiary hospitals between 2008 and 2022. According to pre-operative BMI, the patients were divided into three groups: low BMI (≤18.4 kg/m2), normal BMI (18.5-24.9 kg/m2), and high BMI (≥25.0 kg/m2). The incidence of surgical infection among the three groups was compared. Multivariable logistic regression models were used to determine the independent risk factors associated with surgical infection. Results: A total of 371 patients were enrolled, including 283 patients (76.3%) in the normal BMI group, 30 patients (8.1%) in the low BMI group, and 58 patients (15.6%) in the high BMI group. The incidence of surgical infection was significantly higher in the patients in the low BMI and high BMI groups than in the normal BMI group. The multivariable logistic regression model showed that low BMI and high BMI were independently associated with the occurrence of surgical infection. Conclusions: The pCCA patients with a normal BMI treated with curative resection could have a lower risk of surgical infection than pCCA patients with an abnormal BMI.
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Affiliation(s)
- Jing-Hua Zuo
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiao-Yu Che
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Bin-Bin Tan
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yan Jiang
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jie Bai
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xue-Lei Li
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yi-Shi Yang
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shu-Jie Pang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Xing-Chao Liu
- Department of Hepatobiliary Surgery, Sichuan Provincial People's Hospital, Chengdu, China
| | - Hai-Ning Fan
- Department of Hepatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining, China
| | - Cheng-Cheng Zhang
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jing-Jing Wang
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yan-Qi Zhang
- Department of Health Statistics, College of Military Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hai-Su Dai
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhi-Yu Chen
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lang Gan
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhi-Peng Liu
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Hepato-pancreato-biliary Center, Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
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Dong B, Chen J, Song M, You C, Lei C, Fan Y. The hepatic and pancreatic tumour resection risk factors for surgical site wound infections: A meta-analysis. Int Wound J 2023; 20:3140-3147. [PMID: 37194335 PMCID: PMC10502255 DOI: 10.1111/iwj.14190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 05/18/2023] Open
Abstract
A meta-analysis was conducted to measure hepatic and pancreatic tumour resection (HPTR) risk factors (RFs) for surgical site wound infections (SSWIs). A comprehensive literature inspection was conducted until February 2023, and 2349 interrelated investigations were reviewed. The nine chosen investigations included 22 774 individuals who were in the chosen investigations' starting point, 20 831 of them were with pancreatic tumours (PTs), and 1934 with hepatic tumours (HTs). Odds ratio (OR) and 95% confidence intervals (CIs) were used to compute the value of the HPTR RFs for SSWIs using dichotomous and continuous approaches, and a fixed or random model. HT patients with biliary reconstruction had significantly higher SSWI (OR, 5.81; 95% CI, 3.42-9.88, P < .001) than those without biliary reconstruction. Nevertheless, there was no significant difference between individuals with PT who underwent pancreaticoduodenectomy and those who underwent distal pancreatectomy in SSWI (OR, 1.63; 95% CI, 0.95-2.77, P = .07). HT individuals with biliary reconstruction had significantly higher SSWI compared with those without biliary reconstruction. Nevertheless, there was no significant difference between PT individuals who underwent pancreaticoduodenectomy and those who underwent distal pancreatectomy in SSWI. However, owing to the small number of selected investigations for this meta-analysis, care must be exercised when dealing with its values.
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Affiliation(s)
- Biao Dong
- Department of Neurosurgerythe Fifth Hospital of WuhanWuhanHubeiChina
| | - Jing Chen
- Department of General MedicineErqiao Street Community Health Service Center affiliated of the Fifth Hospital of WuhanWuhanHubeiChina
| | - Mina Song
- Department of Anesthesiologythe Fifth Hospital of WuhanWuhanHubeiChina
| | - Changjiang You
- Department of Emergencythe Fifth Hospital of WuhanHubeiChina
- Department of General MedicineQin Duankou Street Community Health Service Center of the Fifth Hospital of WuhanWuhanHubeiChina
| | - Changjiang Lei
- Department of Oncologythe Fifth Hospital of WuhanWuhanHubeiChina
| | - Ying Fan
- Department of Outpatient Officethe Fifth Hospital of WuhanWuhanHubeiChina
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Shimane T, Koike K, Fujita S, Kurita H, Isomura ET, Chikazu D, Kanno N, Sasaki K, Hino S, Hibi H, Koyama T, Nakamura S, Nomura T, Mori Y, Tojyo I, Yamamoto T, Yamamori I, Aota K, Tanzawa H. Positive impact of perioperative oral management on the risk of surgical site infections after abdominal surgery: Sixteen universities in Japan. Medicine (Baltimore) 2023; 102:e35066. [PMID: 37713859 PMCID: PMC10508462 DOI: 10.1097/md.0000000000035066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/14/2023] [Indexed: 09/17/2023] Open
Abstract
Surgical site infections (SSI) are associated with increased morbidity and mortality rates. This study aimed to investigate the ability of perioperative oral management (POM) to reduce the risk of SSI in abdominal surgery Real-world data collected from 16 university hospitals in Japan were reviewed. The medical records of consecutive 2782 patients (1750 men and 1032 women) who underwent abdominal surgery under general anesthesia at 16 university hospitals were retrospectively reviewed. Detailed information about SSI was assessed and compared between patients with and without POM in univariate and multivariate analyses. SSI were observed in 275 patients (incidence rate:9.9%), and POM was administered to 778 patients (28.0%). Univariate analyses revealed that diabetes mellitus, Eastern Cooperative Oncology Group performance status, American Society of Anesthesiologists classification, surgical site, preoperative Prognostic Nutritional Index score, POM, extent of surgery, operation time, and intraoperative blood loss were significantly associated with postoperative SSI (Chi-square or Mann-Whitney U test, P < .01). Multivariate analysis revealed that POM had significant preventive effects against postoperative SSI (estimate: -0.245, standard error: 0.080, P < .01). Surgical site, American Society of Anesthesiologists classification, and operation time were also significant and independent clinical predictors of SSI. The analysis of real-world data from 16 university hospitals revealed that, regardless of the content and degree of the problem, the addition of POM has significant beneficial effects in reducing the risk of SSI in patients who undergo abdominal surgery. Medical records from each hospital and data from the Health Care Payment Fund were collected and analyzed retrospectively.
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Affiliation(s)
- Tetsu Shimane
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuyuki Koike
- Department of Dentistry and Oral-Maxillofacial Surgery, Chiba University Hospital, Chiba, Japan
| | - Shigeyuki Fujita
- Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Emiko Tanaka Isomura
- First Department of Oral and Maxillofacial Surgery, Osaka University, Graduate School of Dentistry: Unit of Dentistry, Osaka University Hospital, Suita, Japan
| | - Daichi Chikazu
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Naomi Kanno
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Satoshi Hino
- Department of Oral and Maxillofacial Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hideharu Hibi
- Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Koyama
- Division of Oral and Maxillofacial Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Seiji Nakamura
- Section of Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Takeshi Nomura
- Department of Oral Medicine, Oral and maxillofacial Surgery, Tokyo Dental College, Chiba, Japan
| | - Yoshiyuki Mori
- Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical University, Tochigi, Japan
| | - Itaru Tojyo
- Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Japan
| | - Toshiro Yamamoto
- Department of Dental Medicine, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Iku Yamamori
- Department of Dentistry and Oral Surgery, Yamagata University Hospital, Yamagata, Japan
| | - Keiko Aota
- Department of Oral Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hideki Tanzawa
- Department of Dentistry and Oral-Maxillofacial Surgery, Chiba University Hospital, Chiba, Japan
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Pu JL, Xu X, Chen LL, Li C, Jia HD, Fan ZQ, Li JD, Guan MC, Liang YJ, Zhou YH, Wang XM, Gu WM, Wang H, Li J, Chen ZY, Chen TH, Zhang YM, Chen ZX, Yao LQ, Diao YK, Wang MD, Shen F, Pawlik TM, Lau WY, Chen Z, Yang T, Lv GY. Postoperative infectious complications following laparoscopic versus open hepatectomy for hepatocellular carcinoma: a multicenter propensity score analysis of 3876 patients. Int J Surg 2023; 109:2267-2275. [PMID: 37161522 PMCID: PMC10442085 DOI: 10.1097/js9.0000000000000446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Hepatocellular carcinoma (HCC) is a common indication for hepatectomy that is often complicated by postoperative complication. The authors sought to investigate the relationship between the open with laparoscopic approach of hepatectomy and incidences of postoperative infectious complications. PATIENTS AND METHODS Using a multicenter database, HCC patients who underwent laparoscopic hepatectomy (LH) or open hepatectomy (OH) were reviewed and analyzed. Propensity score matching (PSM), inverse probability of treatment weight (IPTW), and multivariate logistic regression analyses were utilized to assess the association of the operative approach with postoperative infectious complications, including incisional surgical site infection (SSI), organ/space SSI, and remote infection (RI). RESULTS Among 3876 patients, 845 (21.8%) and 3031 (78.2%) patients underwent LH and OH, respectively. The overall incidence of infection was 6.9 versus 14.6% among patients who underwent LH versus OH, respectively ( P <0.001). Of note, the incidences of incisional SSI (1.8 vs. 6.3%, P <0.001), organ/space SSI (1.8 vs. 4.6%, P <0.001), and RI (3.8 vs. 9.8%, P <0.001) were all significantly lower among patients who underwent LH versus OH. After PSM (6.9, 1.8, 1.8, and 3.8% vs. 18.5, 8.4, 5.2, and 12.8%, respectively) and IPTW (9.5, 2.3, 2.1, and 5.5% vs. 14.3, 6.3, 4.5, and 9.8%, respectively), LH remained associated with statistically lower incidences of all types of infectious complications. After adjustment for other confounding factors on multivariate analyses, LH remained independently associated with lower incidences of overall infection, incisional SSI, organ/space SSI, and RI in the overall, PSM, and IPTW cohorts, respectively. CONCLUSION Compared with open approach, laparoscopic approach was independently associated with lower incidences of postoperative infectious complications following hepatectomy for HCC.
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Affiliation(s)
- Jia-Le Pu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, Jilin
- Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong
| | - Xiao Xu
- Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong
| | - Lan-Lan Chen
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, Jilin
| | - Chao Li
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
| | - Hang-Dong Jia
- Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang
| | - Zhong-Qi Fan
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, Jilin
| | - Ju-Dong Li
- Department of Pancreatic-biliary Surgery, Changzheng Hospital
| | - Ming-Cheng Guan
- Department of Medical Oncology, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu
| | - Ying-Jian Liang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Harbin Medical University
| | - Ya-Hao Zhou
- Department of Hepatobiliary Surgery, Pu’er People’s Hospital, Pu’er, Yunnan
| | - Xian-Ming Wang
- Department of General Surgery, First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong
| | - Wei-Min Gu
- The First Department of General Surgery, the Fourth Hospital of Harbin, Harbin, Heilongjiang
| | - Hong Wang
- Department of General Surgery, Liuyang People’s Hospital, Liuyang, Hunan
| | - Jie Li
- Department of Hepatobiliary Surgery, Fuyang People’s Hospital, Fuyang
| | - Zhi-Yu Chen
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Ting-Hao Chen
- Department of General Surgery, Ziyang First People’s Hospital, Ziyang, Sichuan
| | - Yao-Ming Zhang
- The Second Department of Hepatobiliary Surgery, Meizhou People’s Hospital, Meizhou, Guangdong
| | - Zi-Xiang Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui
| | - Lan-Qing Yao
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
| | - Yong-Kang Diao
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
| | - Ming-Da Wang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
| | - Feng Shen
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Wan Yee Lau
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
- Faculty of Medicine, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Zhong Chen
- Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong
| | - Tian Yang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, Jilin
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
| | - Guo-Yue Lv
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, Jilin
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Hanaki T, Goto K, Tokuyasu N, Endo Y, Sunada H, Noma H, Sunaguchi T, Murakami Y, Matsunaga T, Yamamoto M, Sakamoto T, Hasegawa T, Fujiwara Y. Efficacy of indocyanine green systemic administration for bile leak detection after hepatectomy: a protocol for a prospective single-arm clinical trial with a historical control group. BMJ Open 2023; 13:e068223. [PMID: 36944457 PMCID: PMC10032385 DOI: 10.1136/bmjopen-2022-068223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Bile leakage (BL) after hepatectomy cannot always be detected with conventional methods; moreover, BL cannot be completely prevented. Recently, navigation procedures with indocyanine green (ICG) have been reported. Furthermore, we previously reported the possibility of detecting BLs with high sensitivity during hepatectomy by administering ICG into the bloodstream, which is quickly excreted in the bile. This study aims to verify whether detecting and addressing ICG leakage from the hepatic dissection plane using an ICG camera can reduce the bilirubin concentration in the drainage fluid, and consequently, the incidence of BL. METHODS AND ANALYSIS This prospective single-centre non-randomised single-arm trial will be conducted with historical controls. Overall, 85 patients will be enrolled, including 40 and 45 in the ICG and historical control groups, respectively. In the ICG group, 10 mg/2 mL of ICG will be transvenously or transportally administered during liver surgery. After its uptake by liver cells and excretion into bile, it will be visualised using a camera following the completion of hepatectomy, and the site of ICG leakage will be sutured. Moreover, we will record the number of bile leak spots detected by the naked eye and ICG camera. The primary endpoint of the study will be the total bilirubin concentration in the drain fluid on postoperative day 3, and we will determine whether the concentration differs significantly between the ICG and historical control groups. The results of our study will be used to suggest whether intraoperative ICG administration and evaluation at the hepatic dissection plane can be widely used in liver surgery for more reliable detection of BL and consequent reduction of biliary fistula. ETHICS AND DISSEMINATION The protocol was approved by the Certified Review Board of Tottori University Hospital (approval number: 21C002). Findings from this trial will be published in peer-reviewed journals and presented at academic conferences. TRIAL REGISTRATION NUMBER jRCTs061210043.
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Affiliation(s)
- Takehiko Hanaki
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Keisuke Goto
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Naruo Tokuyasu
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Yusuke Endo
- Department of Advanced Medicine, Tottori University, Tottori, Japan
| | - Hiroshi Sunada
- Department of Advanced Medicine, Tottori University, Tottori, Japan
| | - Hisashi Noma
- Department of Data Science, Institute of Statistical Mathematics, Tachikawa, Tokyo, Japan
| | - Teppei Sunaguchi
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Yuki Murakami
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Tomoyuki Matsunaga
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Manabu Yamamoto
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Teruhisa Sakamoto
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Toshimichi Hasegawa
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
| | - Yoshiyuki Fujiwara
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine Graduate School of Medicine, Yonago, Tottori, Japan
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Görgec B, Cacciaguerra AB, Aldrighetti LA, Ferrero A, Cillo U, Edwin B, Vivarelli M, Lopez-Ben S, Besselink MG, Abu Hilal M. Incidence and Clinical Impact of Bile Leakage after Laparoscopic and Open Liver Resection: An International Multicenter Propensity Score-Matched Study of 13,379 Patients. J Am Coll Surg 2022; 234:99-112. [PMID: 35213428 DOI: 10.1097/xcs.0000000000000039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite many developments, postoperative bile leakage (POBL) remains a relatively common postoperative complication after laparoscopic liver resection (LLR) and open liver resection (OLR). This study aimed to assess the incidence and clinical impact of POBL in patients undergoing LLR and OLR in a large international multicenter cohort using a propensity score-matched analysis. STUDY DESIGN Patients undergoing LLR or OLR for all indications between January 2000 and October 2019 were retrospectively analyzed using a large, international, multicenter liver database including data from 15 tertiary referral centers. Primary outcome was clinically relevant POBL (CR-POBL), defined as Grade B/C POBL. RESULTS Overall, 13,379 patients met the inclusion criteria and were included in the analysis (6,369 LLR and 7,010 OLR), with 6.0% POBL. After propensity score matching, a total of 3,563 LLR patients were matched to 3,563 OLR patients. In both groups, propensity score matching accounted for similar extent and types of resections. The incidence of CR-POBL was significantly lower in patients after LLR as compared with patients after OLR (2.6% vs 6.0%; p < 0.001). Among the subgroup of patients with CR-POBL, patients after LLR experienced less severe (non-POBL) postoperative complications (10.1% vs 20.9%; p = 0.028), a shorter hospital stay (12.5 vs 17 days; p = 0.001), and a lower 90-day/in-hospital mortality (0% vs 5.4%; p = 0.027) as compared with patients after OLR with CR-POBL. CONCLUSION Patients after LLR seem to experience a lower rate of CR-POBL as compared with the open approach. Our findings suggest that in patients after LLR, the clinical impact of CR-POBL is less than after OLR.
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Affiliation(s)
- Burak Görgec
- From the Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy (Görgec, Cacciaguerra, Abu Hilal)
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK (Görgec, Cacciaguerra, Abu Hilal)
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands (Görgec, Besselink)
| | - Andrea Benedetti Cacciaguerra
- From the Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy (Görgec, Cacciaguerra, Abu Hilal)
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK (Görgec, Cacciaguerra, Abu Hilal)
| | - Luca A Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy (Aldrighetti)
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Turin, Italy (Ferrero)
| | - Umberto Cillo
- Department of Surgery, Oncology, and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, Padova University Hospital, Padova, Italy (Cillo)
| | - Bjørn Edwin
- Department of Hepato-Pancreato-Biliary Surgery and The Intervention Center, Oslo University Hospital, Oslo, Norway (Edwin)
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Norway (Edwin)
| | - Marco Vivarelli
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy (Vivarelli)
| | - Santiago Lopez-Ben
- Unit of Hepato-Biliary and Pancreatic Surgery, Department of General Surgery, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Catalonia, Spain (Lopez-Ben)
| | - Marc G Besselink
- From the Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy (Görgec, Cacciaguerra, Abu Hilal)
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands (Görgec, Besselink)
| | - Mohammed Abu Hilal
- From the Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy (Görgec, Cacciaguerra, Abu Hilal)
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK (Görgec, Cacciaguerra, Abu Hilal)
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7
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Kinoshita M, Shinkawa H, Kabata D, Tanaka S, Takemura S, Amano R, Kimura K, Ohira G, Nishio K, Kubo S. Impact of Advancing Age on the Status and Risk of Postoperative Infections After Liver Resection. World J Surg 2021; 45:3386-3394. [PMID: 34244815 DOI: 10.1007/s00268-021-06236-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Despite the recently increasing number of elderly patients undergoing liver resection, the impact of advancing age on postoperative infections (PIs) incidence and risk remains unclear. This study aimed to investigate the impact of advancing age on PIs incidence and status. METHODS This retrospective study included 744 patients undergoing liver resection without biliary reconstruction or combined resection of other organs. Multivariable analysis with a restricted cubic spline was used to evaluate the impact of advancing age on PIs and to determine its association with PIs risk in patients undergoing open and laparoscopic liver resection (OLR and LLR, respectively). RESULTS Multivariable analysis demonstrated that advancing age was significantly associated with increased PIs risk (P = 0.017). The spline curve showed that the odds ratio for PIs sharply increased starting approximately at 65 years of age. Unadjusted restricted cubic splines assessing the subcategories of PIs demonstrated that advancing age was associated with increased risks of organ/space surgical site infection and sepsis (P = 0,064 and 0.048, respectively). Multivariable analysis revealed that LLR was associated with the lower PIs risk compared with OLR (P = 0.025), whereas the lower PIs risk with LLR was not significantly obscured by advancing age (P = 0.29). CONCLUSIONS Advancing age was associated with increased risk of PIs, including organ/space surgical site infections and sepsis, after liver resection especially in patients aged ≥ 65 years.
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Affiliation(s)
- Masahiko Kinoshita
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Hiroji Shinkawa
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan.
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shogo Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Shigekazu Takemura
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Ryosuke Amano
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Kenjiro Kimura
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Go Ohira
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Kohei Nishio
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
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8
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Mentor K, Ratnayake B, Akter N, Alessandri G, Sen G, French JJ, Manas DM, Hammond JS, Pandanaboyana S. Meta-Analysis and Meta-Regression of Risk Factors for Surgical Site Infections in Hepatic and Pancreatic Resection. World J Surg 2020; 44:4221-4230. [PMID: 32812136 DOI: 10.1007/s00268-020-05741-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The risk factors for surgical site infection (SSI) after HPB surgery are poorly defined. This meta-analysis aimed to quantify the SSI rates and risk factors for SSI after pancreas and liver resection. METHODS The PUBMED, MEDLINE and EMBASE databases were systematically searched using the PRISMA framework. The primary outcome measure was pooled SSI rates. The secondary outcome measure was risk factor profile determination for SSI. RESULTS The overall rate of SSI after pancreatic and liver resection was 25.1 and 10.4%, respectively (p < 0.001). 32% of pancreaticoduodenectomies developed SSI vs 23% after distal pancreatectomy (p < 0.001). The rate of incisional SSI in the pancreatic group was 9% and organ/space SSI 16.5%. Biliary resection during liver surgery was a risk factor for SSI (25.0 vs 15.7%, p = 0.002). After liver resection, the incisional SSI rate was 7.6% and the organ space SSI rate was 10.2%. Pancreas-specific SSI risk factors were pre-operative biliary drainage (p < 0.001), chemotherapy (p < 0.001) and radiotherapy (p = 0.007). Liver-specific SSI risk factors were smoking (p = 0.046), low albumin (p < 0.001) and significant blood loss (p < 0.001). The rate of organ/space SSI in patients with POPF was 47.7% and in patients without POPF 7.3% (p < 0.001). Organ/space SSI rate was 43% in patients with bile leak and 10% in those without (p < 0.001). CONCLUSIONS The risk factors for SSI following pancreatic and liver resections are distinct from each other, with higher SSI rates after pancreatic resection. Pancreaticoduodenectomy has increased risk of SSI compared to distal pancreatectomy. Similarly, biliary resections during liver surgery increase the rates of SSI.
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Affiliation(s)
- Keno Mentor
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bathiya Ratnayake
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nasreen Akter
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Giorgio Alessandri
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gourab Sen
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jeremy J French
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Derek M Manas
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John S Hammond
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sanjay Pandanaboyana
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. .,Population Health Science Institute, Newcastle University, Newcastle upon Tyne, UK.
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9
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Predictive Value of the Age-Adjusted Charlson Comorbidity Index for Outcomes After Hepatic Resection of Hepatocellular Carcinoma. World J Surg 2020; 44:3901-3914. [PMID: 32651603 DOI: 10.1007/s00268-020-05686-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study aimed to evaluate the impact of the age-adjusted Charlson comorbidity index (ACCI) on outcomes after hepatic resection for hepatocellular carcinoma (HCC). METHODS We assessed 763 patients who underwent hepatic resection for HCC. The ACCI scores were categorized as follows: ACCI ≤ 5, ACCI = 6, and ACCI ≥ 7. RESULTS A multivariate analysis showed that the odds ratios for postoperative complications in ACCI = 6 and ACCI ≥ 7 groups, with reference to ACCI ≤ 5 group, were 0.71 (p = 0.41) and 4.15 (p < 0.001), respectively. The hazard ratios for overall survival of ACCI = 6 and ACCI ≥ 7 groups, with reference to ACCI ≤ 5 group, were 1.52 (p = 0.023) and 2.45 (p < 0.001), respectively. The distribution of deaths due to HCC-related, liver-related, and other causes was 68.2%, 11.8%, and 20% in ACCI ≤ 5 group, 47.2%, 13.9%, and 38.9% in ACCI = 6 group, and 27.3%, 9.1%, and 63.6% in ACCI ≥ 7 group (p = 0.053; ACCI ≤ 5 vs. = 6, p = 0.19; ACCI = 6 vs. ≥ 7, p < 0.001; ACCI ≤ 5 vs. ≥ 7). In terms of the treatment for HCC recurrence in ACCI ≤ 5, ACCI = 6, and ACCI ≥ 7 groups, adaptation rate of surgical resection was 20.1%, 7.3%, and 11.1% and the rate of palliative therapy was 4.3%, 12.2%, and 22.2%, respectively. CONCLUSIONS The ACCI predicted the short-term and long-term outcomes after hepatic resection of HCC. These findings will help physicians establish a treatment strategy for HCC patients with comorbidities.
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10
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Effects of preoperative dental examination and oral hygiene instruction on surgical site infection after hepatectomy: a retrospective study. Support Care Cancer 2020; 29:653-659. [PMID: 32424646 DOI: 10.1007/s00520-020-05525-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/09/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE This study retrospectively investigated relationships among risk factors and post-hepatectomy surgical site infection (SSI) and other complications in patients who underwent hepatectomy for hepatocellular carcinoma (HCC). METHODS We included 334 patients who underwent hepatectomies for liver cancers between January 2011 and December 2015 in this study. We evaluated risk factors for SSI and other post-hepatectomy complication, including demographic factors, preoperative factors, and preoperative intervention including oral management, perioperative factors, and length of hospital stay, with univariate and multivariate analyses. The oral management intervention included self-care instructions, extraction of infected teeth, removal of dental plaques and calculus (scaling), professional mechanical teeth cleaning, removal of tongue coating, and cleaning of dentures. SSI was defined in accordance with the guideline issued by the Centers for Disease Control and Prevention; it included purulent discharge from any incision or organ space within 30 days postoperatively, with or without microbiological evidence. Complications of grade II or greater, according to the Clavien-Dindo classification, were regarded as postoperative complications. RESULTS We found bacterial infection of ascites (Odds ratio (OR) = 13.72), lack of preoperative oral management intervention (OR = 10.17), and severe liver fibrosis (OR = 2.76) to be associated with SSI and severe liver fibrosis (OR = 2.28), hypoalbuminemia (OR = 2.02), blood transfusion (OR = 1.86), and longer operation time (OR = 1.80) to be associated with postoperative complications. CONCLUSIONS Preoperative oral management may reduce the risk of SSI in patients with HCC who undergo hepatectomy.
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11
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Chacon E, Eman P, Dugan A, Davenport D, Marti F, Ancheta A, Gupta M, Shah M, Gedaly R. Effect of operative duration on infectious complications and mortality following hepatectomy. HPB (Oxford) 2019; 21:1727-1733. [PMID: 31229489 DOI: 10.1016/j.hpb.2019.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/23/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND To study mortality and infectious complications (IC) risk relative to operative duration in a large and contemporary cohort of patients undergoing hepatectomy. METHODS A retrospective cohort study of 21,443 patients from the National Surgical Quality Improvement Program dataset of patients who underwent liver resection from 2012 to 2016. RESULTS Patients undergoing hepatectomy during the study period (N = 21,443) had a mean operative duration of 243.5 min of which 16.6% (3533) developed at least one IC. The overall 30-day mortality was 1.6%. A significant increase in mortality and IC was demonstrated from 3 h of operating time (OR: 1.99 and OR: 1.94, respectively), peaking at 8 h (OR: 7.15 and OR: 6.37, respectively). Pneumonia, sepsis/septic shock, and SSI presented high prevalence and were linked to significant mortality. After case-matching, elective hepatectomy was associated with a 4-fold increased risk of infectious complications. CONCLUSIONS Operative duration was associated with a linear increased risk of mortality and IC after hepatectomy. The most critical determinants of IC were ASA class, COPD, CHF, and type of hepatectomy.
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Affiliation(s)
- Eduardo Chacon
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA
| | - Pedro Eman
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA
| | - Adam Dugan
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA
| | - Daniel Davenport
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA
| | - Francesc Marti
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA
| | - Alexandre Ancheta
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA
| | - Meera Gupta
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA
| | - Malay Shah
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA
| | - Roberto Gedaly
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA.
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12
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Shen J, Ni Z, Qian Y, Wang B, Zheng S. Clinical prediction score for superficial surgical site infections: Real-life data from a retrospective single-centre analysis of 812 hepatectomies. Int Wound J 2019; 17:16-20. [PMID: 31646746 DOI: 10.1111/iwj.13209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 07/27/2019] [Indexed: 11/30/2022] Open
Abstract
Superficial surgical site infections (SSIs) are one of the most common postoperative complications of hepatectomy for liver cancer. The objective of this study is to clarify the risk factors and determine a clinical prediction score for SSIs after partial hepatectomy for malignant tumour. A total of 812 consecutive patients were enrolled who underwent partial hepatectomy for liver malignant tumour from January 2017 to December 2017. Univariate and multivariate analyses were conducted to identify the risk factors for SSIs. Clinical prediction score was then constructed using coefficients of identified significant predictors. Risk stratification was then carried out by receiver operating characteristic curve analysis. Of all the 812 patients, SSIs were observed in 31 (3.82%) patients. A multivariate analysis identified four predictors as independent risk factors for SSIs, which were splenomegaly, perioperative blood transfusion, intensive care unit (ICU) admission, and low postoperative serum albumin concentration (<35 g/L). Clinical prediction score ranged from 0 to 4.6 with its discrimination concordance (C) statistic of 0.70 (95% confidence interval [CI] 0.59, 0.81). Risk stratification classified these patients into low, moderate, and high risk in SSIs. This risk score system may credibly stratify the risk of SSIs with relatively high sensitivity and specificity. Splenomegaly, history of blood transfusion, ICU admission, and postoperative serum albumin concentration less than 35 g/L could be used to predict SSIs with acceptable discrimination. This clinical risk score system may be useful in prediction of SSIs after hepatectomy for malignant tumours.
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Affiliation(s)
- Juwei Shen
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - Zuowei Ni
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - Yigang Qian
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - Bei Wang
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - Shusen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China
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13
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Tang TY, Zong Y, Shen YN, Guo CX, Zhang XZ, Zou XW, Yao WY, Liang TB, Bai XL. Predicting surgical site infections using a novel nomogram in patients with hepatocelluar carcinoma undergoing hepatectomy. World J Clin Cases 2019; 7:2176-2188. [PMID: 31531313 PMCID: PMC6718804 DOI: 10.12998/wjcc.v7.i16.2176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/22/2019] [Accepted: 07/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Surgical site infections (SSI) remain a major cause of morbidity after hepatectomy for hepatocellular carcinoma (HCC).
AIM To identify the risk factors associated with SSI, and develop a nomogram to predict SSI among patients undergoing hepatectomy.
METHODS We retrospectively reviewed the data of patients diagnosed with HCC undergoing hepatectomy at two academic institutions in China, and evaluated the occurrence of SSI. Independent risk factors for SSI were identified using univariate and multivariate analyses. Based on these independent risk factors, a nomogram was established using the data of patients in the first institution, and was validated using data from an external independent cohort from the second institution.
RESULTS The nomogram was established using data from 309 patients, whereas the validation cohort used data from 331 patients. The operation duration, serum albumin level, repeat hepatectomy, and ASA score were identified as independent risk factors. The concordance index (C-index) of the nomogram for SSI prediction in the training cohort was 0.86; this nomogram also performed well in the external validation cohort, with a C-index of 0.84. Accordingly, we stratified patients into three groups, with a distinct risk range based on the nomogram prediction, to guide clinical practice.
CONCLUSION Our novel nomogram offers good preoperative prediction for SSIs in patients undergoing hepatectomy.
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Affiliation(s)
- Tian-Yu Tang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Yi Zong
- The 5th Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 20000, China
| | - Yi-Nan Shen
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Cheng-Xiang Guo
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Xiao-Zhen Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Xiu-Wen Zou
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Wei-Yun Yao
- Department of Surgery, Changxing People’s Hospital, Huzhou 313000, Zhejiang Province, China
| | - Ting-Bo Liang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Xue-Li Bai
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
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14
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Guo T, Ding R, Yang J, Wu P, Liu P, Liu Z, Li Z. Evaluation of different antibiotic prophylaxis strategies for hepatectomy: A network meta-analysis. Medicine (Baltimore) 2019; 98:e16241. [PMID: 31261586 PMCID: PMC6617204 DOI: 10.1097/md.0000000000016241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The application of antibiotic prophylaxis for hepatectomy remains uncertain. This research aims to evaluate different antibiotic prophylaxis strategies for hepatectomy based on network meta-analysis. METHODS Literature retrieval was conducted in globally recognized databases, namely, MEDLINE, EMBASE and Cochrane Central, to address relative randomized controlled trials (RCTs) investigating antibiotic prophylaxis strategies for hepatectomy. Relative parametric data, including surgical site infection (SSI), remote site infection (RSI) and total infection (TI), were quantitatively pooled and estimated based on the Bayesian theorem. The values of surface under the cumulative ranking curve (SUCRA) probabilities regarding each parameter were calculated and ranked. Node-splitting analysis was performed to test the inconsistency of the main results, and publication bias was assessed by examining the funnel plot symmetry. Additional pairwise meta-analyses were performed to validate the differences between respective strategies at the statistical level. RESULTS After a detailed review, a total of 5 RCTs containing 4 different strategies were included for the network meta-analysis. The results indicated that the application of no antibiotics possessed the highest possibility of having the best clinical effects on SSI (SUCRA, 0.56), RSI (SUCRA, 0.46) and TI (SUCRA, 0.61). Moreover, node-splitting analysis and funnel plot symmetries illustrated no inconsistencies in the current study. Additional pairwise meta-analyses determined that additional and long-duration applications had no clinical benefit. CONCLUSION Based on current evidence, we concluded that antibiotic prophylaxis did not reveal clinical benefit in hepatectomy. However, more relative trials and statistical evidence are still needed.
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Affiliation(s)
- Tao Guo
- Department of Hepatobiliary and Pancreatic Surgery
| | - Ruiwen Ding
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan
| | - Jian Yang
- School of Nursing, Huanggang Polytechnic College, Huanggang, PR China
| | - Ping Wu
- Department of Hepatobiliary and Pancreatic Surgery
| | - Pengpeng Liu
- Department of Hepatobiliary and Pancreatic Surgery
| | - Zhisu Liu
- Department of Hepatobiliary and Pancreatic Surgery
| | - Zhen Li
- Department of Hepatobiliary and Pancreatic Surgery
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15
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Spetzler VN, Schepers M, Pinnschmidt HO, Fischer L, Nashan B, Li J. The incidence and severity of post-hepatectomy bile leaks is affected by surgical indications, preoperative chemotherapy, and surgical procedures. Hepatobiliary Surg Nutr 2019; 8:101-110. [PMID: 31098357 DOI: 10.21037/hbsn.2019.02.06] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Bile leaks are one of the most common complications after liver resection. The International Study Group of Liver Surgery (ISGLS) established a uniform bile leak definition including a severity grading. However, a risk factor assessment according to ISGLS grading as well as the clinical implications has not been studied sufficiently so far. Methods The incidence and grading of bile leaks according to ISGLS were prospectively documented in 501 consecutive liver resections between July 2012 and December 2016. A multivariate regression analysis was performed for risk factor assessment. Association with other surgical complications, 90-day mortality as well as length of hospital stay (LOS) was studied. Results The total rate of bile leaks in this cohort was 14.0%: 2.8% grade A, 8.0% grade B, and 3.2% grade C bile leaks were observed. Preoperative chemotherapy or biliary intervention, diagnosis of hilar cholangiocarcinoma, colorectal metastasis, central minor liver resection, major hepatectomy, extended hepatectomy or two-stage hepatectomy, were some of the risk factors leading to bile leaks. The multivariate regression analysis revealed that preoperative chemotherapy, major hepatectomy and biliodigestive reconstruction remained significant independent risk factors for bile leaks. Grade C bile leaks were associated not only with surgical site infection, but also with an increased 90-day mortality and prolonged LOS. Conclusions The preoperative treatment as well as the surgical procedure had significant influence on the incidence and the severity of bile leaks. Grade C bile leaks were clinically most relevant, and led to significant increased LOS, rate of infection, and mortality.
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Affiliation(s)
- Vinzent N Spetzler
- Department of Hepatobiliary Surgery and Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlene Schepers
- Department of Hepatobiliary Surgery and Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans O Pinnschmidt
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Fischer
- Department of Hepatobiliary Surgery and Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Björn Nashan
- Department of Hepatobiliary Surgery and Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jun Li
- Department of Hepatobiliary Surgery and Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Kostakis ID, Machairas N, Prodromidou A, Garoufalia Z, Charalampoudis P, Sotiropoulos GC. Microbe Isolation from Blood, Central Venous Catheters, and Fluid Collections after Liver Resections. Surg Infect (Larchmt) 2018; 20:49-54. [PMID: 30300569 DOI: 10.1089/sur.2018.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Our goal was to evaluate the microbe species responsible for bacteremia or infections related to central venous catheter (CVC) or fluid collections after liver resection. PATIENTS AND METHODS Data from 112 patients (68 males, 44 females) who underwent liver resection over a period of 63 months were reviewed. Patient and tumor characteristics, intra-operative and post-operative data, and the results from cultures of peripheral blood, CVC tips and drained intra-abdominal or intra-throracic fluid collections were collected. RESULTS There were positive blood cultures in 20 patients (17.9%). Coagulase-negative staphylococci (CoNS) and bacteria of enteric flora were the micro-organisms found most frequently and half of the cases had multiple isolated microbe species. The construction of a bilioenteric anastomosis was an independent risk factor for microbe isolation in peripheral blood (odds ratio [OR]: 11, p = 0.01). Furthermore, there were positive cultures of the CVC tip in 14 patients (12.5%), with CoNS being the micro-organism found most frequently and most cases had only one isolated microbe species. No specific risk factor for catheter-related infections was detected. In addition, there were positive cultures of drained fluid collections in 19 patients (17%), with bacteria of enteric flora being the micro-organisms found most frequently and the majority of cases had multiple isolated microbe species. The construction of a bilioenteric anastomosis (OR: 23.5, p = 0.002) and the laparoscopic approach (OR: 4.7, p = 0.0496) were independent risk factors for microbe isolation in drained fluid collections. Finally, the presence of positive blood cultures was associated with the presence of positive culture of CVC tips (p = 0.018) and drained fluid collections (p = 0.001). CONCLUSIONS Post-operative bacteremia, colonization of CVCs, and contamination of fluid collections occur frequently after liver resections and various microbe species may be involved. Patients who undergo hepatectomy and a synchronous construction of a bilioenteric anastomosis are at increased risk of bacteremia development and contamination of fluid collections.
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Affiliation(s)
- Ioannis D Kostakis
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
| | - Anastasia Prodromidou
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
| | - Zoe Garoufalia
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
| | - Petros Charalampoudis
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
| | - Georgios C Sotiropoulos
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
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17
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The utility of the subcuticular suture in hepatic resection. Contemp Oncol (Pozn) 2018; 22:184-190. [PMID: 30455591 PMCID: PMC6238092 DOI: 10.5114/wo.2018.78940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/09/2018] [Indexed: 12/12/2022] Open
Abstract
Aim of the study Despite recent technical progress and advances in the perioperative management of liver surgery, postoperative surgical site infection (SSI) is still one of the most common complications that extends hospital stays and increases medical expenses following hepatic surgery. Material and methods From 2001 to 2017 a total of 1180 patients who underwent hepatic resection for liver tumours were retrospectively analysed with respect to the predictive factor of superficial incisional SSI, using a propensity score matching by procedure (subcuticular or mattress suture). Results The incidence of superficial and deep incisional SSIs was found to be 7.1% (84/1180). By propensity score matching (PSM), 121 of the 577 subcuticular suture group patients could be matched with 121 of the 603 mattress suture group patients. Multivariate analysis demonstrated wound closure technique as the only independent risk factor that correlated significantly with the occurrence of superficial incisional SSIs (p = 0.038). C-reactive protein (CRP) levels on postoperative day 4 were significantly higher in patients with incisional SSIs than in those without (p < 0.001). Conclusions Wound closure technique with subcuticular continuous spiral suture using absorbable suture should be considered to minimise the incidence of incisional SSIs. Moreover, wounds should be carefully checked when CRP levels are high on postoperative day 4.
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Li L, Ding J, Han J, Wu H. A nomogram prediction of postoperative surgical site infections in patients with perihilar cholangiocarcinoma. Medicine (Baltimore) 2017; 96:e7198. [PMID: 28640107 PMCID: PMC5484215 DOI: 10.1097/md.0000000000007198] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Surgical site infection (SSI) is one of the major morbidities after radical resection for perihilar cholangiocarcinoma (PHCC). This study aimed to clarify the risk factors and construct a nomogram to predict SSIs in patients with PHCC.A total of 335 consecutive patients who underwent hepatectomy combined with hepaticojejunostomy between January 2013 and December 2015 were analyzed retrospectively. SSIs, including incisional (superficial and deep) and space/organ infection, were defined according to the Centers for Disease Control and Prevention (CDC)'s National Nosocomial Infection Surveillance (NNIS) system. Risk factors associated with postoperative SSIs were analyzed by univariate and multivariate analyses. A nomogram was developed on the basis of results from the multivariate logistic model and the discriminatory ability of the model was analyzed.PHCC patients had higher organ/space SSI rate than incisional SSI rate after radical resection. Multivariate analysis showed that risk factors indicating postoperative overall SSIs (incisional and organ/space) included coexisting cholangiolithiasis [odds ratio (OR): 6.77; 95% confidence interval (95% CI): 2.40-19.11; P < .001], blood loss >1500 mL (OR: 4.77; 95% CI: 1.45-15.65; P = .010), having abdominal surgical history (OR: 5.85; 95% CI: 1.91-17.97; P = .002), and bile leakage (OR: 15.28; 95% CI: 5.90-39.62; P < .001). The β coefficients from the multivariate logistic model were used to construct the model for estimation of SSI risk. The scoring model was as follows: -4.12 +1.91 × (coexisting cholangiolithiasis = 1) + 1.77 × (having previous abdominal surgical history = 1) +1.56 × (blood loss >1500 mL = 1) + 2.73 × (bile leakage = 1). The discriminatory ability of the model was good and the area under the receiver operating characteristic (ROC) curve (AUC) was 0.851.In PHCC patients, there may be a relationship between postoperative SSIs and abdominal surgical history, coexisting cholangiolithiasis, bile leakage, and blood loss. The nomogram can be used to estimate the risk of postoperative SSIs in patients with PHCC.
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Affiliation(s)
- Long Li
- Department of General Surgery, Dingxi People's Hospital/Lanzhou University Second Hospital Dingxi Hospital
| | - Jie Ding
- Department of Hepatology, Lanzhou University Second Hospital, Lanzhou
| | - Jun Han
- Department of Critical Care Medicine, Sichuan Provincial Hospital for Women and Children
| | - Hong Wu
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
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Maehara Y, Shirabe K, Kohnoe S, Emi Y, Oki E, Kakeji Y, Baba H, Ikeda M, Kobayashi M, Takayama T, Natsugoe S, Haraguchi M, Yoshida K, Terashima M, Sasako M, Yamaue H, Kokudo N, Uesaka K, Uemoto S, Kosuge T, Sawa Y, Shimada M, Doki Y, Yamamoto M, Taketomi A, Takeuchi M, Akazawa K, Yamanaka T, Shimokawa M. Impact of intra-abdominal absorbable sutures on surgical site infection in gastrointestinal and hepato-biliary-pancreatic surgery: results of a multicenter, randomized, prospective, phase II clinical trial. Surg Today 2017; 47:1060-1071. [PMID: 28233105 DOI: 10.1007/s00595-017-1480-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 01/10/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND The use of absorbable sutures in wound closure has been shown to reduce the incidence of surgical site infection (SSI); however, there is no evidence that the intra-abdominal use of absorbable rather than silk sutures reduces the incidence of SSI after gastrointestinal surgery. We report the findings of a phase II trial, designed to evaluate the impact of the intra-abdominal use of absorbable sutures on the incidence of SSI. METHODS At 19 Japanese hospitals, 1147 patients undergoing elective gastrectomy, colorectal surgery, hepatectomy, or pancreaticoduodenectomy (PD) were randomly assigned to absorbable or silk intra-abdominal suture groups. The primary efficacy endpoint was the incidence of SSI. The secondary efficacy endpoints were the locations of SSI, time to resolution of SSI, length of hospital stay, and the incidence of bile leakage in hepatectomy and pancreatic fistula. RESULTS The incidence of SSI was 11.3%, 15.5%, 11.3%, and 36.9% after gastrectomy, colorectal surgery, hepatectomy, and PD, respectively. The incidence of SSI was higher in the absorbable suture group than in the silk suture group for all the surgical procedures, but the difference was not significant. CONCLUSION The intra-abdominal use of absorbable sutures did not have enough of an effect on the reduction of SSI in this phase II trial to justify the planning of a large-scale phase III trial.
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Affiliation(s)
- Yoshihiko Maehara
- Department of Surgery and Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ken Shirabe
- Department of Surgery and Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Shunji Kohnoe
- Department of Surgery and Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasunori Emi
- Department of Surgery and Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Eiji Oki
- Department of Surgery and Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University, Kobe, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masataka Ikeda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Hospital Administration Section, Kochi Medical School, Kochi, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Masashi Haraguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | | | - Mitsuru Sasako
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoo Kosuge
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Oksaka, Japan
| | - Mitsuo Shimada
- Department of Surgery, The University of Tokushima, Tokushima, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masahiro Takeuchi
- Department of Clinical Medicine (Biostatistics and Pharmaceutical Medicine), School of Pharmacy, Kitasato University, Tokyo, Japan
| | - Kouhei Akazawa
- Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University, Yokohama, Japan
| | - Mototsugu Shimokawa
- Department of Cancer Information Research, Kyushu Cancer Center, Fukuoka, Japan
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20
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Zhou YM, Chen ZY, Li XD, Xu DH, Su X, Li B. Preoperative Antibiotic Prophylaxis Does Not Reduce the Risk of Postoperative Infectious Complications in Patients Undergoing Elective Hepatectomy. Dig Dis Sci 2016; 61:1707-13. [PMID: 26715500 DOI: 10.1007/s10620-015-4008-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/14/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Postoperative infection is not uncommon after hepatectomy. This study assessed the effectiveness of preoperative antibiotic prophylaxis in elective hepatectomy in a randomized clinical trial setting. METHODS A total of 120 patients who were scheduled to undergo elective hepatectomy were equally randomized to receive either intravenous cefuroxime 1.5 g (group A) or placebo (group B) within 30 min prior to skin incision. RESULTS Overall, postoperative infection occurred in 26 (21.6 %) of the 120 patients. There was no statistically significant difference between groups A and B in the incidence of overall infection (23.3 vs. 20.0 %, P = 0.658), surgical site infection (13.3 vs. 15 %, P = 0.793), and remote site infection (13.3 vs. 11.7 %, P = 0.783). CONCLUSION The use of preoperative antibiotic prophylaxis as a routine practice in patients undergoing elective hepatectomy is unnecessary because it does not reduce the risk of postoperative infectious complications.
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Affiliation(s)
- Yan-Ming Zhou
- Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhen-Yi Chen
- Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xiu-Dong Li
- Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Dong-Hui Xu
- Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xu Su
- Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Bin Li
- Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China.
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Effect of 4% chlorhexidine gluconate predisinfection skin scrub prior to hepatectomy: a double-blinded, randomized control study. Int Surg 2016; 99:787-94. [PMID: 25437588 DOI: 10.9738/intsurg-d-13-00179.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This trial was designed to compare the efficacy of 4% chlorhexidine gluconate (CHG) with normal saline (NS) as a predisinfection skin-scrub solution prior to standard presurgical skin preparation. Data was collected at a single transplantation center where patients electing resection of hepatic tumors were recruited between October 2011 and September 2012. In total, 100 patients were consecutively enrolled for random assignment to either 4% CHG or NS as a predisinfection skin-scrub solution prior to surgery. Our aim was to assess the comparative antiseptic efficacy of CHG in this setting, focusing on cutaneous microbial colonization (at baseline, preoperatively, and postoperatively) and postsurgical site infections as primary outcome measures. Positivity rates of baseline, preoperative, and postoperative cultures were similar for both groups, showing significant declines (relative to baseline) after skin preparation and no significant postsurgical rebound. Rates of surgical site infection were also similar in both groups (CHG, 6.0%; NS, 4.1%; P = 1.0). For patients with hepatic tumors undergoing hepatectomy, the effect of 4% CHG as a predisinfection scrub solution was similar to that of NS in terms of skin decontamination and surgical site infections.
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22
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Synbiotics in Surgery for Chronic Pancreatitis: Are They Truly Effective? A Single-blind Prospective Randomized Control Trial. Ann Surg 2015; 262:31-7. [PMID: 25575262 DOI: 10.1097/sla.0000000000001077] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Postoperative infectious complications in patients undergoing pancreatic surgery are a significant cause for morbidity and mortality. Although synbiotics have beneficial effects on human health, their clinical value in surgical patients remains unclear given a paucity of applicable clinical studies. AIM To determine the impact of perioperative synbiotic therapy on postoperative infectious complications, morbidity and mortality in patients undergoing pancreatic surgery for chronic pancreatitis. METHODS A trial was conducted in patients with chronic calcific pancreatitis undergoing Frey's procedure. Group A received a specific synbiotic composition, 5 days prior and 10 days after the surgery. Group B received a placebo. Primary study endpoint was the occurrence of postoperative infection during the first 30 days. Secondary outcome measures were mortality, length of hospital stay, days in intensive care unit, and duration of antibiotic therapy. Using previously accrued data, with α of 0.05 and power 80%, the sample size was calculated as 35 patients for each group with a dropout rate of 10%. RESULTS Of the 79 patients enrolled, 75 completed the trial [group A (n = 39) and group B (n = 36)]. The incidence of postoperative infectious complications (12.8% vs 39%; P < 0.05), duration of antibiotics therapy (P < 0.05), and length of hospital stay (P < 0.05) were significantly lower in the synbiotic group. CONCLUSIONS Synbiotics significantly reduce septic complications, hospital stay, and antibiotic requirement in patients undergoing pancreatic surgery for chronic pancreatitis. Furthermore, basic and clinical research would clarify the underlying mechanisms of their therapeutic effect and define the appropriate conditions for use.
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Laparoscopic liver resection for treating recurrent hepatocellular carcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 20:512-7. [PMID: 23404252 DOI: 10.1007/s00534-012-0592-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is still unknown whether laparoscopic liver resection is suitable for recurrent hepatocellular carcinoma (HCC) after previous curative hepatic resection. METHOD The perioperative outcomes of 40 patients treated with second surgery for recurrent HCC by partial hepatectomy were studied retrospectively. The second surgery was performed under laparotomy in 20 patients (laparotomy group) and under laparoscopy in 20 patients (laparoscopy group). RESULTS Intraoperative blood loss (p < 0.0001) and the incidence of postoperative complications (p = 0.0004) were lower in the laparoscopy group than in the laparotomy group. The incidence rates of surgical site infection and intractable ascites were significantly higher in the laparotomy group than in the laparoscopy group (p = 0.0202, p = 0.0436, respectively). The proportion of patients classified as Clavien grade IIIa was higher in the laparotomy group than in the laparoscopy group (p = 0.0033). The duration of the postoperative hospital stay was significantly shorter in the laparoscopy group than in the laparotomy group (p < 0.0001). CONCLUSIONS Postoperative morbidity has been decreased by the introduction of laparoscopic liver resection in patients with recurrent HCC after curative hepatic resection. As a result, the duration of the postoperative stay is shorter.
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Nakayama H, Takayama T, Okubo T, Higaki T, Midorikawa Y, Moriguchi M, Aramaki O, Yamazaki S. Subcutaneous drainage to prevent wound infection in liver resection: a randomized controlled trial. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 21:509-17. [DOI: 10.1002/jhbp.93] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Hisashi Nakayama
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
| | - Takao Okubo
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
| | - Tokio Higaki
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
| | - Yutaka Midorikawa
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
| | - Masamichi Moriguchi
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
| | - Osamu Aramaki
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
| | - Shintaro Yamazaki
- Department of Digestive Surgery; Nihon University School of Medicine; 30-1 Oyaguchikami-machi Itabashi-ku Tokyo 173-8610 Japan
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25
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Nanashima A, Arai J, Oyama S, Ishii M, Abo T, Wada H, Takagi K, Tsuchiya T, Nagayasu T. Associated factors with surgical site infections after hepatectomy: predictions and countermeasures by a retrospective cohort study. Int J Surg 2014; 12:310-4. [PMID: 24509400 DOI: 10.1016/j.ijsu.2014.01.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/03/2013] [Accepted: 01/20/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND To clarify the factors associated with post-hepatectomy surgical site infections (SSIs), the clinicopathological data of 526 patients who underwent hepatectomy was retrospectively examined as a retrospectively cohort study. METHODS Patient demographics, liver functions, histological findings, surgical records and post-hepatectomy morbidity were compared between non-SSI and SSI groups; the SSI group included superficial and deep SSIs. RESULTS The prevalence of SSIs (5-8%) has not changed over an 18-year period. Deep SSIs were significantly more increased in male patients with lower performance statuses and American Society of Anesthesiologists (ASA) scores (p < 0.05). SSIs tended to be less prevalent, although not significant (p = 0.10), in patients who underwent laparoscopic hepatectomies compared to those who underwent laparotomies. For patients in whom hemostatic devices were used, the prevalence of superficial SSIs was significantly lower than those in whom the devices were not used (p < 0.05). Blood loss and transfusion were significantly more frequent in the deep SSI group compared to other groups (p < 0.01). Hospital stay in the deep SSI group was significantly longer compared to other groups. The incidence of morbidity was more frequent in the SSI groups compared with the non-SSI group (p < 0.001). A multivariate analysis showed that not using a vessel sealing device was significantly associated with superficial SSIs; male gender, hepatic failure and bile leakage were significantly associated with deep SSIs (p < 0.05). CONCLUSIONS SSIs were important indicators of patient outcomes after hepatectomies, and preventing SSI development after surgical procedures is an important step in improving the overall prevalence of SSIs.
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Affiliation(s)
- Atsushi Nanashima
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan.
| | - Junichi Arai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
| | - Syousaburo Oyama
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
| | - Mitsutoshi Ishii
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
| | - Takafumi Abo
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
| | - Hideo Wada
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
| | - Katsunori Takagi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
| | - Tomoshi Tsuchiya
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
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Yang T, Tu PA, Zhang H, Lu JH, Shen YN, Yuan SX, Lau WY, Lai ECH, Lu CD, Wu MC, Li JW, Shen F. Risk factors of surgical site infection after hepatic resection. Infect Control Hosp Epidemiol 2014; 35:317-20. [PMID: 24521601 DOI: 10.1086/675278] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A study of 7,388 consecutive patients after hepatic resection between 2011 and 2012 identified hepatolithiasis, cirrhosis, and intraoperative blood transfusion as the only independent risk factors of both incisional and organ/space surgical site infection (SSI). Patients with these conditions should be cared for with caution to lower SSI rates.
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Affiliation(s)
- Tian Yang
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
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Hirokawa F, Hayashi M, Miyamoto Y, Asakuma M, Shimizu T, Komeda K, Inoue Y, Uchiyama K, Nishimura Y. Evaluation of postoperative antibiotic prophylaxis after liver resection: a randomized controlled trial. Am J Surg 2013; 206:8-15. [DOI: 10.1016/j.amjsurg.2012.08.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 08/09/2012] [Accepted: 08/19/2012] [Indexed: 10/26/2022]
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28
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Kanazawa A, Tsukamoto T, Shimizu S, Kodai S, Yamazoe S, Yamamoto S, Kubo S. Impact of laparoscopic liver resection for hepatocellular carcinoma with F4-liver cirrhosis. Surg Endosc 2013; 27:2592-7. [PMID: 23392977 DOI: 10.1007/s00464-013-2795-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 01/07/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although the utility of laparoscopic liver resection for hepatocellular carcinoma (HCC) has been recognized in recent years, the impact of the laparoscopic liver resection for HCC with complete liver cirrhosis (F4) is still unknown. METHODS Retrospective analysis of 56 patients who underwent partial hepatectomy for HCC (3 cm or smaller in a diameter) and had complete liver cirrhosis (F4) diagnosed histologically was performed. Of the 56 patients, partial hepatectomy was performed under laparotomy in 28 patients (laparotomy group) or under laparoscopy in 28 patients (laparoscopy group). Perioperative outcome was analyzed in the two groups. RESULTS There were no significant differences in the results of the preoperative liver function tests and the operation time between the two groups. The intraoperative blood loss was lower in the laparoscopy group than the laparotomy group (p = 0.0003). The incidence of the postoperative complications was significantly higher in the laparotomy group (20/36 patients) than in the laparoscopy group (3/28 patients, p < 0.0001). The incidences of surgical site infection, especially incisional infection, and intractable ascites were significantly higher in the laparotomy group than in the laparoscopy group (p = 0.0095, p < 0.0001, respectively). The proportions of patients who were classified into Clavien's grade I and IIIa were higher in the laparotomy group than in the laparoscopy group (p = 0.0043, p = 0.051, respectively). The duration of the postoperative hospital stay was significantly shorter in the laparoscopy group than in the laparotomy group (p < 0.0001). CONCLUSIONS The postoperative morbidity, such as surgical site infection and intractable ascites, decreased by the induction of laparoscopic liver resection in patients with liver cirrhosis. As the results, the necessity of invasive treatment for postoperative complications decreased and the duration of the postoperative stay was shortened.
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Affiliation(s)
- Akishige Kanazawa
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-Hondori, Miyakojima-ku, Osaka 534-0021, Japan.
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29
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Rayes N, Pilarski T, Stockmann M, Bengmark S, Neuhaus P, Seehofer D. Effect of pre- and probiotics on liver regeneration after resection: a randomised, double-blind pilot study. Benef Microbes 2013; 3:237-44. [PMID: 22968413 DOI: 10.3920/bm2012.0006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Liver regeneration is a prerequisite for extended liver surgery. Several studies have shown that the bacterial gut flora is able to modulate liver function. Previously we observed that synbiotics could partly reverse the impaired mitosis rate of hepatocytes in a rat model of synchronous liver resection and colon anastomosis. The effect of synbiotics on liver function after hepatic resection has not been analysed yet. A prospective randomised double-blind pilot trial was undertaken in 19 patients scheduled for right hepatectomy. All patients received enteral nutrition immediately post-operatively. Comparison was made between a group receiving a combination of four probiotics and four fibres and a placebo group receiving the fibres only starting the day before surgery and continuing for 10 days. Primary study endpoint was the liver function capacity measured by 13C-methacetin breath test and indocyanine green plasma disappearance rate. Portal vein flow, liver volumetry, laboratory parameters for liver function, length of hospital stay, post-operative complications and side effects of synbiotic therapy were recorded. Liver function capacity was comparable in both groups. Complications had a negative impact on liver function. Because complications were more severe in the verum group, a sub-analysis was performed. In case of an uncomplicated course, liver function capacity was better in the patients with synbiotics. No severe side effects occurred. Synbiotics might be able to increase liver function capacity in patients after liver resection, but patient numbers were too small and the clinical courses too heterogeneous to draw any definite conclusions.
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Affiliation(s)
- N Rayes
- Department of General-, Visceral- and Transplant Surgery, Charité Campus Virchow, Augustenburger Platz 1, 13353 Berlin, Germany.
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Sadamori H, Yagi T, Shinoura S, Umeda Y, Yoshida R, Satoh D, Nobuoka D, Utsumi M, Fujiwara T. Risk factors for major morbidity after liver resection for hepatocellular carcinoma. Br J Surg 2012; 100:122-9. [DOI: 10.1002/bjs.8957] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2012] [Indexed: 12/11/2022]
Abstract
Abstract
Background
Bile leakage, and organ and/or space surgical-site infection (SSI) are common causes of major morbidity after partial hepatectomy for hepatocellular carcinoma (HCC). The purpose of this study was to analyse risk factors for major morbidity and to explore strategies for its reduction after partial hepatectomy for HCC.
Methods
Risk factors for bile leakage and organ/space SSI were analysed in patients who underwent partial hepatectomy for HCC between 2001 and 2010. The causes, management and outcomes of intractable bile leakage requiring endoscopic therapy or percutaneous transhepatic biliary drainage were analysed. In addition, causative bacteria, outcomes and characteristics of organ/space SSI were investigated. Risk factors were identified using multivariable analysis.
Results
Some 359 patients were included in the analysis. The prevalence of bile leakage and organ/space SSI was 12·8 and 8·6 per cent respectively. Repeat hepatectomy and an operating time of at least 300 min were identified as independent risk factors for bile leakage. The main causes of intractable bile leakage were latent strictures of the biliary system caused by previous treatments for HCC and intraoperative injury of the hepatic duct during repeat hepatectomy. Independent risk factors for organ/space SSI were repeat hepatectomy and bile leakage. Methicillin-resistant Staphylococcus aureus was detected more frequently in organ/space SSI after repeat hepatectomy than after initial partial hepatectomy.
Conclusion
Repeat hepatectomy and prolonged surgery were identified as risk factors for bile leakage after liver resection for HCC. Bile leakage and repeat hepatectomy increased the risk of organ/space SSI.
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Affiliation(s)
- H Sadamori
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - T Yagi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - S Shinoura
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - Y Umeda
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - R Yoshida
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - D Satoh
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - D Nobuoka
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - M Utsumi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
| | - T Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama 700-8558, Japan
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Moreno Elola-Olaso A, Davenport DL, Hundley JC, Daily MF, Gedaly R. Predictors of surgical site infection after liver resection: a multicentre analysis using National Surgical Quality Improvement Program data. HPB (Oxford) 2012. [PMID: 22221576 DOI: 10.1111/j.1477–2574.2011.00417.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Postoperative infections are frequent complications after liver resection and have significant impact on length of stay, morbidity and mortality. Surgical site infection (SSI) is the most common nosocomial infection in surgical patients, accounting for 38% of all such infections. OBJECTIVES This study aimed to identify predictors of SSI and organ space SSI after liver resection. METHODS Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for patients who underwent liver resection in 2005, 2006 or 2007 in any of 173 hospitals throughout the USA were analysed. All patients who underwent a segmental resection, left hepatectomy, right hepatectomy or trisectionectomy were included. RESULTS The ACS-NSQIP database contained 2332 patients who underwent hepatectomy during 2005-2007. Rates of SSI varied significantly across primary procedures, ranging from 9.7% in segmental resection patients to 18.3% in trisectionectomy patients. A preoperative open wound, hypernatraemia, hypoalbuminaemia, elevated serum bilirubin, dialysis and longer operative time were independent predictors for SSI and for organ space SSI. CONCLUSIONS These findings may contribute towards the identification of patients at risk for SSI and the development of strategies to reduce the incidence of SSI and subsequent costs after liver resection.
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Affiliation(s)
- Almudena Moreno Elola-Olaso
- Transplantation and Hepatobiliary Center, University of Kentucky College of Medicine, 800 Rose Street, Lexington, KY 40536-0293, USA
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Moreno Elola-Olaso A, Davenport DL, Hundley JC, Daily MF, Gedaly R. Predictors of surgical site infection after liver resection: a multicentre analysis using National Surgical Quality Improvement Program data. HPB (Oxford) 2012; 14:136-41. [PMID: 22221576 PMCID: PMC3277057 DOI: 10.1111/j.1477-2574.2011.00417.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Postoperative infections are frequent complications after liver resection and have significant impact on length of stay, morbidity and mortality. Surgical site infection (SSI) is the most common nosocomial infection in surgical patients, accounting for 38% of all such infections. OBJECTIVES This study aimed to identify predictors of SSI and organ space SSI after liver resection. METHODS Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for patients who underwent liver resection in 2005, 2006 or 2007 in any of 173 hospitals throughout the USA were analysed. All patients who underwent a segmental resection, left hepatectomy, right hepatectomy or trisectionectomy were included. RESULTS The ACS-NSQIP database contained 2332 patients who underwent hepatectomy during 2005-2007. Rates of SSI varied significantly across primary procedures, ranging from 9.7% in segmental resection patients to 18.3% in trisectionectomy patients. A preoperative open wound, hypernatraemia, hypoalbuminaemia, elevated serum bilirubin, dialysis and longer operative time were independent predictors for SSI and for organ space SSI. CONCLUSIONS These findings may contribute towards the identification of patients at risk for SSI and the development of strategies to reduce the incidence of SSI and subsequent costs after liver resection.
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Affiliation(s)
- Almudena Moreno Elola-Olaso
- Transplantation and Hepatobiliary Center, University of Kentucky College of Medicine, 800 Rose Street, Lexington, KY 40536-0293, USA
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Sadamori H, Yagi T, Shinoura S, Umeda Y, Yoshida R, Satoh D, Nobuoka D, Utsumi M, Yoshida K, Fujiwara T. Risk factors for organ/space surgical site infection after hepatectomy for hepatocellular carcinoma in 359 recent cases. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2012; 20:186-96. [DOI: 10.1007/s00534-011-0503-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Hiroshi Sadamori
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Takahito Yagi
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Susumu Shinoura
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Yuzo Umeda
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Ryuichi Yoshida
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Daisuke Satoh
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Daisuke Nobuoka
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Masashi Utsumi
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Kazuhiro Yoshida
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2-5-1 Shikata Okayama 700-8558 Japan
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Effect of intra-abdominal absorbable sutures on surgical site infection. Surg Today 2011; 42:52-9. [PMID: 22068675 DOI: 10.1007/s00595-011-0024-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 01/12/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To establish whether the rates of surgical site infection (SSI) in gastrointestinal surgery are affected by the type of intra-abdominal suturing: sutureless, absorbable material (polyglactin: Vicryl), and silk. METHODS We conducted SSI surveillance prospectively at 25 hospitals. RESULTS The overall SSI rate was 14.4% (130/903). The SSI rates in the sutureless, Vicryl, and silk groups were 4.8, 14.8, and 16.4%, respectively, without significant differences among the groups. In colorectal surgery, the SSI rate in the Vicryl group was 13.9%, which was significantly lower than that of the silk group (22.4%; P = 0.034). The incidence of deeper SSIs in the Vicryl group, including deep incisional and organ/space SSIs, was significantly lower than that in the silk group (P = 0.04). The SSI rates did not differ among the suture types overall, in gastric surgery, or in appendectomy. CONCLUSION Using intra-abdominal absorbable sutures instead of silk sutures may reduce the risk of SSI, but only in colorectal surgery.
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Harimoto N, Shirabe K, Abe T, Yukaya T, Tsujita E, Gion T, Kajiyama K, Nagaie T. Prospective randomized controlled trial investigating the type of sutures used during hepatectomy. World J Gastroenterol 2011; 17:2338-42. [PMID: 21633600 PMCID: PMC3098402 DOI: 10.3748/wjg.v17.i18.2338] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 11/25/2010] [Accepted: 12/02/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine whether absorbable sutures or non-absorbable sutures are better in preventing surgical site infection (SSI), in this paper we discuss the results of a randomized clinical trial which examined the type of sutures used during hepatectomy.
METHODS: All hepatic resections performed from January 2007 to November 2008 at the Department of Surgery at Iizuka Hospital in Japan were included in this study. There were 125 patients randomly assigned to an absorbable sutures (Vicryl) group or non-absorbable sutures (Silk) group.
RESULTS: SSI was observed in 13.6% (17/125) patients participating in this study, 11.3% in the Vicryl group and 15.8% in the Silk group. Incisional SSI including superficial and deep SSI, was observed in 8% of the Vicryl group and 9.5% of the Silk group. Organ/space SSI was observed in 3.2% of the Vicryl group and 6.0% of the Silk group. There were no significant differences, but among the patients with SSI, the period for recovery was significantly shorter for the Vicryl group compared to the Silk group.
CONCLUSION: The incidence of SSI in patients receiving absorbable sutures and silk sutures is not significantly different in this randomized controlled study; however, the period for recovery in patients with SSI was significantly shorter for absorbable sutures.
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Risk factors for postoperative infectious complications after hepatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2010; 18:67-73. [DOI: 10.1007/s00534-010-0313-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Reducing the incidence of post-hepatectomy hepatic complications by preoperatively applying parameters predictive of liver function. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2010; 17:871-8. [DOI: 10.1007/s00534-010-0281-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Accepted: 03/08/2010] [Indexed: 12/29/2022]
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Risk factors for major morbidity after hepatectomy for hepatocellular carcinoma in 293 recent cases. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2010; 17:709-18. [PMID: 20703850 DOI: 10.1007/s00534-010-0275-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Accepted: 02/12/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to identify risk factors for major morbidity after hepatectomies for hepatocellular carcinoma (HCC). METHODS Univariate and multivariate analyses of risk factors for major morbidity were performed in 293 patients who underwent hepatectomy for HCC between 2001 and 2008. RESULTS Two hundred and forty-three patients (82.9%) underwent an anatomic hepatectomy, and a repeat hepatectomy was performed in 50 patients (17.1%). The prevalences of bile leakage and intraabdominal abscess were 12.9% and 9.2%, respectively. The risk factor for bile leakage was an operative time >or= 300 min and the risk factor for intraabdominal abscess was a repeat hepatectomy (odds ratios = 4.9 and 5.3, respectively). The main cause of bile leakage that made endoscopic therapy or percutaneous transhepatic biliary drainage necessary was a latent stricture of the biliary anatomy that had existed preoperatively, caused by previous treatments for HCC. Methicillin-resistant Staphylococcus aureus was the main causative bacteria of intraabdominal abscess after repeat hepatectomies. CONCLUSIONS Our recent series revealed that prolonged operative time and repeat hepatectomy were independent risk factors for bile leakage and intraabdominal abscess, respectively, after hepatectomies for HCC. Preoperative assessment of the biliary anatomy should be considered for patients who have had previous multiple treatments for HCC, including hepatectomy, to reduce bile leakage that makes invasive treatment necessary.
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Okabayashi T, Nishimori I, Maeda H, Yamashita K, Yatabe T, Hanazaki K. Effect of intensive insulin therapy using a closed-loop glycemic control system in hepatic resection patients: a prospective randomized clinical trial. Diabetes Care 2009; 32:1425-7. [PMID: 19435954 PMCID: PMC2713620 DOI: 10.2337/dc08-2107] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Intensive insulin therapy (IIT) reduces morbidity and mortality in patients in surgical intensive care units. The aim of this study is to assess the effect of IIT using a closed-loop system in hepatectomized patients. RESEARCH DESIGN AND METHODS Patients were randomly assigned to receive IIT using a closed-loop system: an artificial pancreas (AP group) or conventional insulin therapy using the sliding-scale method (SS group). RESULTS The incidence of surgical-site infection in the AP group was significantly lower than that in the SS group. The length of hospitalization required for patients in the AP group was significantly shorter than that in the SS group. CONCLUSIONS Total hospital costs for patients in the AP group were significantly lower than for patients in the SS group. IIT using a closed-loop system maintained near-normoglycemia and contributed to a reduction in the incidence of SSI and total hospital costs due to shortened hospitalization.
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Prebiotics, probiotics, synbiotics in surgery--are they only trendy, truly effective or even dangerous? Langenbecks Arch Surg 2008; 394:547-55. [PMID: 19084991 DOI: 10.1007/s00423-008-0445-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 10/22/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite advances in surgical technique and intensive care medicine, nosocomial bacterial infections frequently occur in patients after major abdominal surgery and have a negative impact on operative outcome and hospital costs. In parallel, the routine use of antibiotics led to the development of resistance. Some probiotics (living bacteria) and prebiotics (fibers) are able to stabilize the intestinal barrier and prevent bacterial translocation and infections. The aim of this article was to review all available experience with pro- and prebiotics in surgical trials. MATERIALS AND METHODS Medical databases were searched for animal trials and randomized controlled studies with pro- and prebiotics in surgical patients. Primary endpoint of all reported studies was the occurrence of bacterial infections. In addition, type and concentration of the pro- and prebiotics, duration of therapy, adverse events, and other effects were investigated. RESULTS In three animal trials and in ten of the 15 clinical studies, probiotics or synbiotics led to a significant reduction of bacterial infection rates compared to the control groups. In two studies, there was a positive trend in the groups with synbiotics, but the results were not statistically significant. Two studies showed no effect, and in one study, the mortality rate was even higher in the synbiotic group. Except in the latter study, no severe adverse events were observed. The success of treatment depends on the synbiotic preparation and the length of therapy. Patients after surgery of the liver and pancreas and multiple trauma patients profited most from synbiotic treatment. CONCLUSION The existing randomized controlled trials demonstrated a positive effect of synbiotics in patients with high-risk operations; however, synbiotic preparations should be extensively tested before using them in clinical trials.
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Kobayashi S, Gotohda N, Nakagohri T, Takahashi S, Konishi M, Kinoshita T. Risk Factors of Surgical Site Infection After Hepatectomy for Liver Cancers. World J Surg 2008; 33:312-7. [DOI: 10.1007/s00268-008-9831-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Outcome of and risk factors for incisional hernia after partial hepatectomy. J Gastrointest Surg 2008; 12:1115-20. [PMID: 18213504 DOI: 10.1007/s11605-008-0469-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 01/07/2008] [Indexed: 01/31/2023]
Abstract
INTRODUCTION This study was conducted to analyze differences among abdominal incisions, and risk factors for incisional hernia after partial hepatectomy. MATERIALS AND METHODS In 626 posthepatectomy cases, we analyzed retrospectively the distribution regarding the type of incision and assessed risk factors for incisional hernia. RESULTS Of the patients, 95 (15.2%) had median incisions, 233 (37.2%) had J-shaped incisions, 206 (32.9%) had right transverse incisions with vertical extensions in the midline from the subumbilical region to the xiphoid process (RTVE), and 92 (14.7%) had bilateral transverse incision with a vertical extension to the xiphoid process (a reversed T incision). The respective frequencies of incisional hernia after median, J-shaped, RTVE, and reversed T incisions were 6.3, 4.7, 5.4, and 21.7%, so that the difference between reversed T and other incisions was significant. A diagnosis of "no hernia" required a minimum follow-up of 12 months. The risk factors for incisional hernia were incision type, postoperative ascites, body mass index, repeat hepatectomy, and steroid use in multivariate analysis. CONCLUSION The incidence of incisional hernia after reversed T incision was significantly higher than after other incisions. If incision extension is necessary, the midline incision should be extended from the subumbilical region.
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Morioka D, Tanaka K, Takeda K, Matsuo K, Kimura J, Yahagi S, Endo I, Sekido H, Togo S, Shimada H. Delayed Bile Leakage From a Remaining Part of Segment 8 in a Posterior Section Graft After Living Donor Liver Transplantation: A Common Pitfall in Harvesting a Posterior Section Graft? A Case Report. Transplant Proc 2007; 39:3515-8. [DOI: 10.1016/j.transproceed.2007.07.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Revised: 03/27/2007] [Accepted: 07/21/2007] [Indexed: 10/22/2022]
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