Identification and validation of risk factors for postoperative infectious complications following hepatectomy
Patrick Pessaux1, Maartje A J van den Broek, Tao Wu
1Department of Hepato-Biliary and Pancreatic Surgery, Nouvel Hopital Civil, Université de Strasbourg, IHU MixSurg, IRCAD, 1 place de l'hôpital, 67091, Strasbourg, France, patrick.pessaux@chru-strasbourg.fr.
Unlabelled:
Postoperative infectious complications (PICs) are associated with significant morbidity after abdominal surgery. Using multivariate analysis of data from a prospective database, our study focused on the risk factors for PICs and the prevention of these complications after hepatectomy, with the goal of improving outcomes and reducing the length of hospital stays.
Background:
PICs following surgery are associated with significant morbidity, increase the length of hospital stays, and have a negative impact on long-term oncological outcome. The aim of this study was to determine the risk factors for PICs following partial hepatectomy and to validate these results with an external database.
Methods:
Between January 2006 and December 2009, 555 patients underwent elective partial hepatectomy. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. The dependent variables studied were the occurrence of PICs, defined as development of one or more of the following conditions: pneumonia, sepsis, Central line-associated bloodstream infection, urinary tract infection, wound infection, and infected intra-abdominal fluid collection. PICs were devised in medical (PIMCs) and surgical (PISCs) complications. The incidence of PICs and validation of the predictive score were determined using an external prospective database of 342 patients.
Results:
The multivariate analysis identified three independent risk factors for PICs: the presence of a nasogastric tube (OR = 1.8), blood transfusion (OR = 1.9), and diabetes (OR = 2.4). The multivariate analysis identified only one independent risk factor for PISCs: an associated portal venous resection (OR = 5.5). The multivariate analysis identified four independent risk factors for PIMCs: presence of a biliary drainage (OR = 1.9), blood transfusion (OR = 2.1), diabetes (OR = 2.9), and presence of atrial fibrillation (OR = 3.6). According to the three predictive factors, the observed rates of PICs ranged from 18.8 % to 77.8 % and ranged from 24.2 % to 100 % in the external database. Predicted and observed risks of PICs were not statistically different.
Conclusions:
The correction of modifiable risk factors among the identified factors could reduce the incidence of PICs and, as a consequence, improve patient outcomes and reduce the length of hospital stays.
Insights
Postoperative infectious complications (PICs) after hepatectomy are linked to nasogastric tubes, blood transfusions, and diabetes. Addressing these modifiable risk factors can improve patient outcomes and shorten hospital stays.
Area of Science:
- Abdominal Surgery
- Hepatectomy
- Infectious Complications
Background:
- Postoperative infectious complications (PICs) significantly increase morbidity, hospital stays, and negatively impact oncological outcomes.
- Identifying risk factors for PICs after hepatectomy is crucial for improving patient care.
Purpose of the Study:
- To determine independent risk factors for PICs following partial hepatectomy.
- To validate predictive scores for PICs using an external patient database.
Main Methods:
- Multivariate analysis of prospectively collected data from 555 patients undergoing elective partial hepatectomy.
- Analysis included demographic, pathological, and perioperative variables.
- PICs were defined as pneumonia, sepsis, bloodstream infections, UTIs, wound infections, or intra-abdominal fluid collections.
Main Results:
- Independent risk factors for PICs included nasogastric tube use (OR=1.8), blood transfusion (OR=1.9), and diabetes (OR=2.4).
- Independent risk factors for surgical PICs (PISCs) included portal venous resection (OR=5.5).
- Independent risk factors for medical PICs (PIMCs) included biliary drainage (OR=1.9), blood transfusion (OR=2.1), diabetes (OR=2.9), and atrial fibrillation (OR=3.6).
- Predicted and observed PIC rates showed no statistical difference between internal and external databases.
Conclusions:
- Correction of modifiable risk factors such as nasogastric tube use, blood transfusions, and diabetes management can reduce PIC incidence.
- Reducing PICs is expected to improve patient outcomes and decrease hospital length of stay after hepatectomy.
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