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Selective Decontamination of the Digestive Tract in Pancreatic Head Resections-A Propensity Score-Matched Analysis
Olga Radulova-Mauersberger1, Florian Oehme1,2, Alexandra Doerell1
1Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
Abstract:
(1) Background: The postoperative morbidity rate after pancreatic head resection remains high, partly due to infectious complications. The primary aim of this study was to analyze the influence of selective decontamination of the digestive tract (SDD) on the postoperative infection rate after pancreatic surgery. (2) Methods: From January 2019, the standard of care for patients undergoing pancreatic head resections at the Department for Visceral, Thoracic, and Vascular Surgery, University Hospital Dresden was the preoperative oral administration of SDD. The influence of SDD was evaluated for patients operated on between January 2019 and June 2020 in comparison to a propensity score-matched cohort, extracted from an existing database including all pancreatic resections from 2012 to 2018. The primary endpoint of the study was the shift of the bacterial load on the intraoperative bile swab test. The secondary endpoint was the association of SDD with postoperative complications. (3) Results: In total, 200 patients either with SDD (n = 100; 50%) or without SDD (non-SDD, n = 100; 50%) were analyzed. In the patient group without a preoperative biliary stent, 44% (n = 11) of the non-SDD group displayed positive bacterial results, whereas that was the case for only 21.7% (n = 10) in the SDD group (p = 0.05). Particularly, Enterobacter species (spp.) were reduced from 41.2% (n = 14) (non-SDD group) to 23.5% (n = 12) (SDD group) (p = 0.08), and Citrobacter spp. were reduced by 13.7% (p = 0.09) from the non-SDD to the SDD cohort. In patients with a preoperative biliary stent, the Gram-negative Enterobacter spp. were significantly reduced from 52.2% (n = 12) in the non-SDD group to 26.8% (n = 11) in the SDD group (p = 0.04). Similarly, Citrobacter spp. decreased by 20.6% from 30.4% (n = 7) to 9.8% (n = 4) in the non-SDD compared to the SDD group (p = 0.04). In general, deep fluid collection and abscesses occurred more frequently in the non-SDD group (36%; n = 36 vs. 27%; n = 27; p = 0.17). (4) Conclusions: Adoption of SDD before pancreatic head surgery may reduce the bacterial load in bile fluid. SDD administration does not significantly affect the postoperative infectious complication rate after pancreatic head resections.
Insights
Selective decontamination of the digestive tract (SDD) before pancreatic surgery may reduce bacterial load in bile. However, SDD did not significantly impact postoperative infectious complications in patients undergoing pancreatic head resections.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Infectious Diseases
Background:
- Postoperative morbidity after pancreatic head resection is high, often due to infections.
- Selective decontamination of the digestive tract (SDD) is a potential strategy to mitigate these complications.
Purpose of the Study:
- To evaluate the impact of preoperative oral SDD on postoperative infection rates following pancreatic head resection.
- To analyze the effect of SDD on bacterial load in intraoperative bile samples.
Main Methods:
- A propensity score-matched analysis compared patients undergoing pancreatic head resection with (n=100) and without (n=100) preoperative SDD.
- Data were collected from January 2019 to June 2020, with a historical cohort from 2012-2018.
- Primary endpoint: bacterial load in intraoperative bile swabs; Secondary endpoint: postoperative complications.
Main Results:
- SDD showed a trend towards reducing bacterial presence in bile, particularly Gram-negative bacteria like Enterobacter spp. and Citrobacter spp., especially in patients with preoperative biliary stents.
- While deep fluid collections and abscesses were more frequent in the non-SDD group (36% vs. 27%), this difference was not statistically significant (p=0.17).
Conclusions:
- Preoperative SDD administration may decrease bacterial load in bile during pancreatic head surgery.
- SDD did not demonstrate a significant reduction in the overall rate of postoperative infectious complications after pancreatic head resections.
