Perioperative antibiotherapy should replace prophylactic antibiotics in patients undergoing pancreaticoduodenectomy preceded by preoperative biliary drainage.
Aged
Anti-Bacterial Agents
/ therapeutic use
Antibiotic Prophylaxis
/ adverse effects
Drainage
/ adverse effects
Female
Follow-Up Studies
Humans
Male
Middle Aged
Pancreatic Neoplasms
/ surgery
Pancreaticoduodenectomy
/ adverse effects
Perioperative Care
Piperacillin, Tazobactam Drug Combination
/ therapeutic use
Postoperative Complications
/ etiology
Preoperative Care
Prognosis
Surgical Wound Infection
/ etiology
complications
morbidity
pancreatic fistula
pancreaticoduodenectomy
perioperative antibiotherapy
preoperative biliary drainage
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
received:
31
05
2019
accepted:
23
06
2019
pubmed:
13
7
2019
medline:
7
9
2019
entrez:
13
7
2019
Statut:
ppublish
Résumé
Pancreaticoduodenectomy (PD) remains a morbid surgery. Preoperative biliary drainage (PBD) is often necessary before surgery but is associated with biliary contamination. We compared the postoperative complications of patients undergoing PBD who received the usual prophylactic antibiotics (PAs) or systematic antibiotherapy (ABT). All patients who underwent surgery between 2008 and 2017 were included. Systematic perioperative ABT with piperacillin + tazobactam (ABT group) was implemented in 2014 as the standard of care for PBD. Patients treated in the period before such implementation, during which standard cefazolin was given, served as the controls (PAs group). The primary outcomes were postoperative complications. We included 122 patients with PBD who underwent surgery. There were no demographic differences between the two groups. Perioperative ABT was associated with a reduction in deep abdominal abscesses (36% vs 10%, P = .0008), respiratory tract infections (15% vs 3%; P = .02), bacteremia (41% vs 6%; P < .0001), and a shorter length of hospital stay (17 [13-27] vs 13 [10-14] days; P < .0001). ABT was a protective factor against the development of deep abdominal abscesses (odds ratio [OR] = 0.16; P = .001) whereas smoking (OR = 3.9) and pancreatic fistula (OR = 19.1) were risk factors. Systematic perioperative ABT in patients undergoing PD preceded by PBD may reduce deep surgical infections and the length of hospital stay.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Pancreaticoduodenectomy (PD) remains a morbid surgery. Preoperative biliary drainage (PBD) is often necessary before surgery but is associated with biliary contamination. We compared the postoperative complications of patients undergoing PBD who received the usual prophylactic antibiotics (PAs) or systematic antibiotherapy (ABT).
METHODS
METHODS
All patients who underwent surgery between 2008 and 2017 were included. Systematic perioperative ABT with piperacillin + tazobactam (ABT group) was implemented in 2014 as the standard of care for PBD. Patients treated in the period before such implementation, during which standard cefazolin was given, served as the controls (PAs group). The primary outcomes were postoperative complications.
RESULTS
RESULTS
We included 122 patients with PBD who underwent surgery. There were no demographic differences between the two groups. Perioperative ABT was associated with a reduction in deep abdominal abscesses (36% vs 10%, P = .0008), respiratory tract infections (15% vs 3%; P = .02), bacteremia (41% vs 6%; P < .0001), and a shorter length of hospital stay (17 [13-27] vs 13 [10-14] days; P < .0001). ABT was a protective factor against the development of deep abdominal abscesses (odds ratio [OR] = 0.16; P = .001) whereas smoking (OR = 3.9) and pancreatic fistula (OR = 19.1) were risk factors.
CONCLUSION
CONCLUSIONS
Systematic perioperative ABT in patients undergoing PD preceded by PBD may reduce deep surgical infections and the length of hospital stay.
Substances chimiques
Anti-Bacterial Agents
0
Piperacillin, Tazobactam Drug Combination
157044-21-8
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
639-645Informations de copyright
© 2019 Wiley Periodicals, Inc.