Perioperative Broad-spectrum Antibiotics are Associated With Decreased Surgical Site Infections Compared to 1st–3rd Generation Cephalosporins After Open Pancreaticoduodenectomy in Patients With Jaundice or a Biliary Stent
| Autor: | Lyonell B. Kone, Mihaela Banulescu, Carolina Torres, Vijay K. Maker, Ajay V. Maker |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class medicine.medical_treatment Cephalosporin Antibiotics Jaundice Pancreaticoduodenectomy 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans Surgical Wound Infection Prospective Studies Retrospective Studies business.industry Odds ratio Perioperative Antibiotic Prophylaxis Anti-Bacterial Agents Cephalosporins Surgery 030220 oncology & carcinogenesis Pancreatectomy Propensity score matching Stents 030211 gastroenterology & hepatology medicine.symptom business |
| Zdroj: | Annals of Surgery. 275:1175-1183 |
| ISSN: | 1528-1140 0003-4932 |
| DOI: | 10.1097/sla.0000000000004216 |
| Popis: | OBJECTIVE Compare the effectiveness of 1st-3rd generation cephalosporins (1st-3rdCE) to broad-spectrum antibiotics in decreasing surgical site infections (SSI) after pancreatectomy. SUMMARY OF BACKGROUND DATA SSI is one of the most common complications after pancreatic surgery. Various antibiotic regimens are utilized nationwide with no clear guidelines for pancreatectomy. As we await results of a recently initiated prospective trial, this study retrospectively evaluates over 15,000 patients using the same administrative data abstraction tools as in the trial. METHODS All relevant clinical variables were collected from the 2016-2018 targeted-pancreatectomy database from the American College of Surgeon National Surgical Quality Improvement Program. Preoperative antibiotics were initially collected as first-generation cephalosporin, second or third-generation cephalosporin, and broad-spectrum antibiotics (Broad-abx). RESULTS Of the 15,182 patients who completed a pancreatic surgery between 2016 and 2018, 6114 (40%) received a first-generation cephalosporin, 4097 (27%) received a second or third-generation cephalosporin, and 4971 (33%) received Broad-abx. On multivariate analysis, Broad-abx was associated with a decrease in all-type SSI compared to 1st-3rdCE (odds ratio = 0.73-0.77, P < 0.001) after open pancreaticoduodenectomy (PD). There was no difference in SSI between antibiotic-types after distal pancreatectomy. Subgroup multivariate analysis of open PD revealed decrease in all-type SSI with Broad-abx amongst patients with jaundice and/or biliary stent only, regardless of wound protector use (odds ratio = 0.69-0.70, P < 0.001). Propensity score matching of open PD patients with jaundice and/or biliary stent confirmed a decrease in all-type SSI (19% vs 24%, P = 0.001), and organ-space SSI (12% vs 16%, P < 0.001). CONCLUSION Broad-abx are associated with decreased SSI after open PD and may be preferred specifically for patients with preoperative biliary stent and/or jaundice. |
| Databáze: | OpenAIRE |
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