Abstract
BackgroundThe 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. MethodsThe 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). ResultsThe 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). ConclusionGiven 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.
Highlights
The primary aim of this study was to evaluate the predictive role of intraoperative bile cultures (IOBCs) in the occurrence of abdominal infectious complications in patients undergoing pancreatoduodenectomy
Positive IOBCs were not associated with the occurrence of organ space infection (OSI), which was confirmed by the meta-analysis on abdominal infectious complications
Only 8% of patients developed an isolated OSI, which was not associated with IOBC status
Summary
Pancreatoduodenectomy remains a complex and technically demanding procedure with high rates of morbidity (25–52%) and mortality (1–3%).[1,2,3,4] Infectious complications, such as surgical site infections (SSIs) and organ space infections (OSIs), are reported as the most common complications following pancreatoduodenectomy besides pancreatic fistula and delayed gastric emptying.[5,6] Previous studies showed an association between preoperative biliary drainage, contamination of intraoperative bile cultures (IOBCs) and the occurrence of postoperative infectious complications, SSIs.[1,7,8,9,10] biliary drainage is not routinely recommended, the number of patients requiring this preoperative procedure is expected to rise due to the increasing use of neoadjuvant chemotherapy in pancreatic cancer.[11,12]Patients with a biliary stent appear to have different IOBC contamination patterns.[3,4,8] neoadjuvant treatment is associated with an alteration of the biliary microbiome.[13]. Pancreatoduodenectomy remains a complex and technically demanding procedure with high rates of morbidity (25–52%) and mortality (1–3%).[1,2,3,4] Infectious complications, such as surgical site infections (SSIs) and organ space infections (OSIs), are reported as the most common complications following pancreatoduodenectomy besides pancreatic fistula and delayed gastric emptying.[5,6] Previous studies showed an association between preoperative biliary drainage, contamination of intraoperative bile cultures (IOBCs) and the occurrence of postoperative infectious complications, SSIs.[1,7,8,9,10]. 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
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