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Understanding risk factors and microbial trends implicated in the development of Whipple-related surgical-site
Wendy Feng1, Ahmer Irfan1,2, Molly Fleece1,3
1University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States.
Objective:
The purpose of this study is to understand the role of risk factors and postoperative complications seen in patients undergoing Whipple procedures in the development of surgical site infections. Our secondary goal was to evaluate whether microbial patterns differed between preoperative antibiotic classes, offering insight into the effectiveness of current practices while promoting antibiotic stewardship.
Design:
We performed a retrospective cohort study comparing patients with and without SSIs.
Setting:
This study was conducted at a tertiary-care center in the southeastern United States.
Participants:
Patients who underwent a Whipple procedure between 2012 and 2021 were acquired from the National Surgical Quality Improvement Program (NSQIP) database.
Results:
Patients with a bleeding disorder reported higher SSI rates (P = .04), whereas patients with a biliary stent reported lower surgical site infection (SSI) rates (P = .02) Those with postoperative complications had higher SSI rates, including delayed gastric emptying (P < .001) and pancreatic fistula (P < .001). Patients with longer operative times were 1.002 times more likely to develop SSIs (adjusted odds ratio [aOR], 1.002; 95% confidence interval [CI], 1.001-1.004; P = .006) whereas surgical indications for malignancy correlated with decreased SSIs risk (aOR, 0.578; 95% CI, 0.386-866) when adjusting for body mass index, surgical indication, and duration of surgical procedure.
Conclusions:
Optimizing preoperative management of modifiable risk factors for patients undergoing pancreatoduodenectomies and decreasing operative times may reduce SSI rates and patient and hospital burden. Further research is needed to understand whether stent placement reduces SSI risk in pancreatoduodenectomy.
Insights
Risk factors like bleeding disorders and longer operative times increase surgical site infections (SSIs) after Whipple procedures. Postoperative complications and biliary stents also impact SSI rates, guiding improved patient management.
Area of Science:
- Surgical Oncology
- Infectious Disease Epidemiology
- Patient Safety
Background:
- Surgical site infections (SSIs) are a significant concern following Whipple procedures.
- Identifying risk factors and complications is crucial for improving patient outcomes and reducing healthcare burdens.
Purpose of the Study:
- To investigate the association between risk factors, postoperative complications, and the incidence of SSIs in patients undergoing Whipple procedures.
- To explore microbial patterns related to preoperative antibiotic use for antibiotic stewardship.
Main Methods:
- A retrospective cohort study design was employed.
- Data from patients who underwent Whipple procedures between 2012 and 2021 were analyzed using the National Surgical Quality Improvement Program (NSQIP) database.
- Patients were compared based on the presence or absence of SSIs.
Main Results:
- Patients with bleeding disorders (P = .04) and longer operative times (aOR, 1.002; P = .006) exhibited higher SSI rates.
- Postoperative complications, specifically delayed gastric emptying (P < .001) and pancreatic fistula (P < .001), were strongly associated with increased SSIs.
- Biliary stent placement was linked to lower SSI rates (P = .02), while malignancy as a surgical indication correlated with decreased SSI risk (aOR, 0.578).
Conclusions:
- Optimizing preoperative management of modifiable risk factors and reducing operative times may decrease SSI rates.
- Further research is warranted to elucidate the protective role of stent placement in reducing SSIs after pancreatoduodenectomy.
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