Prophylactic Perioperative Antibiotics in Open Pancreaticoduodenectomy: When Less Is More and When It Is Not. A National Surgical Quality Improvement Program Propensity-Matched Analysis.

Autor: Naffouje SA; GI Oncology Program, Moffitt Cancer Center, Tampa, Florida., Allenson K; GI Oncology Program, Moffitt Cancer Center, Tampa, Florida., Hodul P; GI Oncology Program, Moffitt Cancer Center, Tampa, Florida., Malafa M; GI Oncology Program, Moffitt Cancer Center, Tampa, Florida., Pimiento JM; GI Oncology Program, Moffitt Cancer Center, Tampa, Florida., Anaya DA; GI Oncology Program, Moffitt Cancer Center, Tampa, Florida., Dam A; GI Oncology Program, Moffitt Cancer Center, Tampa, Florida., Klapman J; GI Oncology Program, Moffitt Cancer Center, Tampa, Florida., Fleming JB; GI Oncology Program, Moffitt Cancer Center, Tampa, Florida., Denbo JW; GI Oncology Program, Moffitt Cancer Center, Tampa, Florida. Electronic address: Jason.Denbo@moffitt.org.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2022 Nov; Vol. 279, pp. 722-732. Date of Electronic Publication: 2022 Aug 04.
DOI: 10.1016/j.jss.2022.06.028
Abstrakt: Introduction: We hypothesized that first-generation cephalosporins (G1CEP) provide adequate antimicrobial coverage for pancreaticoduodenectomy (PD) when no biliary stent is present but might be inferior to second-generation cephalosporins or broad-spectrum antibiotics (G2CEP/BS) in decreasing surgical-site infection (SSI) rates when a biliary stent is present.
Methods: The National Surgical Quality Improvement Program 2014-2019 was used to select patients who underwent elective open PD. We divided the population into no-stent versus stent groups based on the status of biliary drainage and then divided each group into G1CEP versus G2CEP/BS subgroups based on the choice of perioperative antibiotics. We matched the subgroups per a propensity score match and analyzed postoperative outcomes.
Results: Six thousand two hundred forty five cases of 39,779 were selected; 2821 in the no-stent (45.2%) versus 3424 (54.8%) in the stent group. G1CEP were the antibiotics of choice in 2653 (42.5%) versus G2CEP/BS in 3592 (57.5%) cases. In the no-stent group, we matched 1129 patients between G1CEP and G2CEP/BS. There was no difference in SSI-specific complications (20.3% versus 21.0%; P = 0.677), general infectious complications (25.7% versus 26.9%; P = 0.503), PD-specific complications, overall morbidity, length of stay, or mortality. In the stent group, we matched 1244 pairs. G2CEP/BS had fewer SSI-specific complications (19.9% versus 26.6%; P < 0.001), collections requiring drainage (9.6% versus 12.9%; P = 0.011), and general infectious complications (28.5% versus 34.1%; P = 0.002) but no difference in overall morbidity, mortality, length of stay, and readmission rates.
Conclusions: G2CEP/BS are associated with reduced rates of SSI-specific and infectious complications in stented patients undergoing open elective PD. In patients without prior biliary drainage, G1CEP seems to provide adequate antimicrobial coverage.
(Copyright © 2022. Published by Elsevier Inc.)
Databáze: MEDLINE
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