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Clinical implications of bile cultures obtained during pancreatoduodenectomy: a cohort study and meta-analysis
Jesse V Groen1, Daphne H M Droogh1, Mark G J de Boer2
1Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Background:
The association between intraoperative bile cultures and infectious complications after pancreatoduodenectomy remains unclear. This cohort study and meta-analysis aimed to determine the predictive role of intraoperative bile cultures in abdominal infectious complications after pancreatoduodenectomy.
Methods:
The cohort study included 114 patients undergoing pancreatoduodenectomy. Regression analyses were used to estimate the odds to develop an organ space infection (OSI) or isolated OSI (OSIs without a simultaneous complication potentially contaminating the intraabdominal space) after a positive bile culture. A systematic review and meta-analysis was performed on abdominal infectious complications (Mantel-Haenszel fixed-effect model).
Results:
The positive bile culture rate was 61%, predominantly in patients after preoperative biliary drainage (98% vs 26%, p < 0.001). OSIs occurred in 35 patients (31%) and isolated OSIs in nine patients (8%) and were not associated with positive bile cultures (OSIs: odds ratio = 0.6, 95% CI = 0.25-1.23, isolated OSIs: odds ratio = 0.77, 95% CI = 0.20-3.04). In the meta-analysis, 15 studies reporting on 2047 patients showed no association between positive bile cultures and abdominal infectious complications (pooled odds ratio = 1.3, 95% CI = 0.98-1.65).
Conclusion:
Given the rare occurrence of isolated OSIs and similar odds for patients with positive and negative bile cultures to develop abdominal infectious complications, routine performance of bile cultures should be reconsidered.
Insights
Intraoperative bile cultures do not predict infectious complications like organ space infections (OSIs) after pancreatoduodenectomy. Routine bile cultures may not be necessary, as positive and negative results showed similar complication rates.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Infectious Diseases
Background:
- The predictive value of intraoperative bile cultures for post-pancreatoduodenectomy infectious complications is not well-established.
- Pancreatoduodenectomy is a complex surgery with a risk of abdominal infectious complications.
Purpose of the Study:
- To evaluate the association between intraoperative bile cultures and abdominal infectious complications following pancreatoduodenectomy.
- To determine if positive bile cultures can predict the occurrence of organ space infections (OSIs).
Main Methods:
- A cohort study of 114 patients undergoing pancreatoduodenectomy.
- Regression analyses to assess the odds of OSI or isolated OSI after positive bile culture.
- A systematic review and meta-analysis of 15 studies (2047 patients) on abdominal infectious complications.
Main Results:
- Positive bile culture rate was 61%, significantly higher in patients with preoperative biliary drainage (98% vs 26%).
- No association was found between positive bile cultures and OSIs (OR=0.6) or isolated OSIs (OR=0.77).
- Meta-analysis of 15 studies (2047 patients) also showed no significant association between positive bile cultures and abdominal infectious complications (pooled OR=1.3).
Conclusions:
- Positive intraoperative bile cultures do not reliably predict abdominal infectious complications after pancreatoduodenectomy.
- The similar risk of complications regardless of bile culture status suggests routine cultures may be reconsidered.
- Further investigation into isolated OSIs is limited due to their rare occurrence.
