Incidence Of Postoperative Infectious Complications Research Articles

Safety and efficacy of vacuum-assisted mini-percutaneous nephrolithotomy for the treatment of renal stone disease: an analysis of stone free status and postoperative infectious complications.

Vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) is being increasingly adopted due to its faster operating times and lower incidence of postoperative infectious complications (IC), however, studies have been limited by small sample sizes. We hypothesize that vmPCNL is an efficacious treatment for renal stone disease with acceptable stone-free rates (SFR) and low incidence of IC. The objectives of this study were to measure SFR three months after surgery, determine the factors influencing SFR, and determine the rates of postoperative IC after vmPCNL. Seven hundred and sixty seven patients underwent vmPCNL for the treatment of renal stones > 20 mm at a single institution. Patients underwent postoperative computed tomography at three months to assess SFR. Postoperative fever and SIRS/Sepsis were recorded for individual patients. Multivariate logistics regression was performed to assess predictors of SFR. The SFR was found to be 73.7% at three months. Stone burden (OR 0.39, 95% CI [0.33-0.46]) and age (OR 1.03, 95% CI [1.01-1.04]) emerged as statistically significant predictors of SFR on multivariate analysis. 5.5% of patients experienced postoperative fever, while 2.9% experienced SIRS/Sepsis. This is the largest continuous cohort of patients to undergo vmPCNL for stone disease and demonstrates that vmPCNL is safe and efficacious, with an SFR of 74% at three months. The incidence of postoperative fever and SIRS/Sepsis is 5.5% and 2.9% respectively. Further randomized studies with large sample sizes are required to ascertain the rates of these complications in comparison to conventional approaches.

Impact of infectious complications after gastrectomy on non‑gastric cancer‑related deaths.

Infectious complications (ICs) have been reported as major causes of postoperative mortality in patients with cancer. However, to the best of our knowledge, the impact of ICs after gastrectomy on non-gastric cancer-related deaths (NGCDs) remains unexplored. The present study aimed to identify the impact of ICs after gastrectomy on NGCDs. A retrospective analysis of 712 patients with gastric cancer who underwent curative gastrectomy was conducted. The participants were categorized into IC and non-IC groups based on the incidence of postoperative IC. Clinicopathological factors and non-gastric cancer-related survival (NGCS) rates were compared between groups. Further NGCD and associated risk factor analyses were performed in a background factor-adjusted cohort using multivariate analysis. Among the 712 patients, 112 developed ICs (Clavien-Dindo classification grade ≥II). In the entire cohort, the IC group had a significantly worse 5-year cumulative incidence of NGCD (17.8 vs. 10.6%; Gray's P=0.021) compared with the non-IC group. Although a number of clinicopathological factors differed between the groups, including patient background, operative factors and tumor factors, the risk factors for NGCD identified in the multivariate analysis were older age, low prognostic nutritional index, low skeletal muscle index and Charlson comorbidity index ≥1, excluding IC incidents. The IC group exhibited more background factors contributing to NGCDs, suggesting a potential increase in NGCD regardless of IC incidence.

Low incidence of postoperative infectious complications following laparoscopic distal gastrectomy for locally advanced gastric cancer in older adult patients above 75 years: Propensity score-matched comparison with open distal gastrectomy.

This study compared the short-term outcomes of older adult patients with locally advanced gastric cancer who underwent open distal gastrectomy (ODG) with those who underwent laparoscopic distal gastrectomy (LDG) using propensity score matching analysis. Overall, 341 consecutive older adult patients aged 75 years with gastric cancer who underwent ODG or LDG between January 2013 and December 2020 were retrospectively assessed. Among them, 121 patients with locally advanced gastric cancer were included. To compare short-term outcomes, a 1:1 propensity score matching analysis was performed. After matching, 29 patients were included in both groups. Compared with the ODG group, the LDG group had a longer operative time (mean, 290 vs. 190 min; p < .0001) and lower estimated blood loss (mean, 39 vs. 223 mL; p < .0001). Overall postoperative complications of grade 2 and higher were observed in 2 (6.9%) and 12 (41%) patients in the LDG and ODG groups, respectively (p = .0046). Of these, the LDG group had a significantly lower incidence rate of infectious complications than the ODG group (3.4% vs. 27.6%; p = .025). Furthermore, in multivariate analysis, the laparoscopic approach was an independent protective factor against postoperative complications (p = .029). LDG is safe and feasible for locally advanced gastric cancer in patients aged ≥75 years. Moreover, it may be a promising alternative to ODG with better short-term outcomes, including significantly lower incidence rates of postoperative complications.

Clinical Significance of Prognostic Nutrition Index in Patients with Crohn's Disease after Primary Bowel Resection.

Although advancements in medical treatments have been made, approximately half of patients with intestinal Crohn's disease (CD) require intestinal resections during their lifetime. It is well-known that the nutritional status of CD patients can impact postoperative morbidity. The objective of this study was to evaluate the clinical significance of prognostic nutritional index (PNI) in patients with intestinal CD who underwent primary bowel resection. We retrospectively investigated patients who were diagnosed with CD and underwent intestinal surgery at Severance Hospital between January 2005 and October 2018. The patients were divided into two groups: PNI ≤40 (n=150) and PNI >40 (n=77). We assessed the clinical significance of PNI in terms of the incidence of postoperative infectious complications (PICs) and the postoperative recurrence of CD. The low PNI group had significantly higher rates of infectious complications (32.0% vs. 10.4%, p=0.001) compared to the high PNI group. Multivariable analysis identified low PNI (≤40) and longer operation time (>180 min) as independent risk factors associated with PICs [odds ratio (OR)=2.754, 95% confidence interval (CI)=1.140-6.649, p=0.024; OR=2.986, 95% CI=1.451-6.143, p=0.003]. PICs were significantly associated with surgical recurrence (hazard ratio=2.217, 95% CI=1.064-4.617, p=0.034). Preoperative PNI could serve as a predictive factor for PICs in CD patients who undergo intestinal resection. Additionally, PICs are significantly associated with a higher risk of surgical recurrence in CD.

Postoperative inflammatory response in colorectal cancer surgery: a meta-analysis.

Surgical removal of the cancerous tissue remains the cornerstone of curative treatment for colorectal cancer and results in an inflammatory response. An exaggerated inflammatory response has been implicated in the promotion of tumor proliferation and has shown associations with postoperative complications. Literature on the preferred surgical technique to minimize inflammatory response is inconclusive. Therefore, the aim of this study was to assess the inflammatory response and postoperative incidence of infectious complications following surgery for colorectal cancer. Embase, PubMed, and Cochrane databases were searched for RCTs that reported inflammatory parameters as a function of surgical modality only. Data related to CRP or IL-6 levels on postoperative days 1 and 3 and data related to postoperative infections were subject to a pairwise meta-analysis to compare open versus laparoscopic techniques. The literature search and screening process yielded 4151 studies. Ten studies met criteria, including 568 patients. Only studies on laparoscopic and open surgery were found. Pooled analyses found lower Il-6 and CRP levels on postoperative day 1 and lower CRP levels on postoperative day 3 for laparoscopic surgery compared to open surgery. However, there was no difference in incidence of postoperative infectious complications. The findings of this study indicate a superior inflammatory profile for laparoscopic surgery compared to an open approach for colorectal cancer surgery. For future research, it would be worthwhile to conduct a randomized controlled trial to compare the postoperative inflammatory response and related clinical outcomes between minimally invasive surgical approaches, including laparoscopic and robot-assisted surgery.

Skeletal Muscle Loss During Neoadjuvant Chemotherapy Predicts the Incidence of Postoperative Infectious Complications in Esophageal Cancer Patients Undergoing Esophagectomy.

Malnutrition, immune deficiency, and skeletal muscle loss are associated with a risk of postoperative complications in patients with various types of cancer. This study evaluated whether malnutrition, immunological deficiencies, and skeletal muscle loss during neoadjuvant chemotherapy (NAC) predict postoperative complications in patients with esophageal cancer. We retrospectively reviewed 123 patients with esophageal squamous cell carcinoma treated with NAC and esophagectomy at our hospital between 2014 and 2019. Patients were divided into two groups based on the presence or absence of postoperative infectious complications, such as pneumonia, anastomotic leakage, surgical site infections, pyothorax, acalculous cholecystitis, and peripheral phlebitis. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and Onodera prognostic nutritional index were used as indicators of systemic inflammation and nutritional status. Skeletal muscle mass was evaluated using the skeletal muscle index (SMI), calculated by evaluating the total cross-sectional area of muscle tissue at the third lumbar level in computed tomography imaging. Univariable and multivariable logistic regression analyses were used to identify predictors of postoperative infectious complications. Postoperative infectious complications occurred in 41 patients (33.3%). A reduction in SMI was observed in 105 patients (87.8%) during NAC. Univariable and multivariable analyses indicated that the reduction in SMI during NAC was an independent predictor of postoperative complications (odds ratio=0.89; 95% confidence interval=0.79-0.99; p=0.048). Skeletal muscle loss during NAC is a useful predictor of postoperative complications in patients with esophageal cancer undergoing esophagectomy.

Influence of bacteriobilia on postoperative complications in patients with periampullary tumors

BackgroundPeriampullary tumours (PAT) may cause obstruction of distal choledochus. The bile stasis is a risk factor for microbial colonisation of bile (bacteriobilia), cholangitis, hepatic insufficiency and coagulopathy. PAT obstruction can be managed surgically or non-operatively - by inserting a biliary drain or stent (BDS). Although BDS allows for adequate bile drainage, liver function restitution and coagulopathy, increased bacteriobilia has been reported and this is associated with an increased incidence of postoperative complications. MethodsA monocentric, prospective, comparative study including 100 patients operated with PAT. The effects of bacteriobilia and the presence of a drain in the biliary tract on the development of postoperative complications were evaluated. ResultsPositive microbial findings in bile were found in 67% of patients. It was 98% in the biliary drain group vs. 36% in non-drained patients (p = 0.0001). In 68% 2 or more different bacterial strains were simultaneously present (p = 0.0001). Patients with a positive microbial finding in bile had more frequent incidence of infectious complications 40.2% (27) vs. 9.1% (3); p = 0.0011. The most frequent infectious complication was wound infection 29.8% (20) vs. 3.03% (1); p = 0.0014. Similarly, a higher incidence of postoperative infectious complications occurred in patients with BDS - 36% (18) vs. 24% (12); p = 0.2752. ConclusionThe presence of a drain or stent in the biliary tract significantly increases the microbial colonisation of bile. It is associated with a significant increase in infectious complications, especially infections in the wound.

Probiotics and synbiotics for preventing postoperative infectious complications in colorectal cancer patients: a systematic review and meta-analysis.

The health benefits of probiotics and synbiotics in healthy adults are well established, but their role in preventing infectious complications after surgery for colorectal cancer remains controversial. The aim of this meta-analysis was to assess the impact of probiotics/synbiotics on the incidence of infectious complications in patients who had surgery for colorectal cancer. A comprehensive literature search of all randomized control trials (RCTs) was conducted using PubMed, Embase, World Health Organization (WHO) Global Index Medicus, WHO clinical trial registry, and Clinicaltrials.gov. Inclusion criteria included RCTs comparing the use of any strain or dose of a specified probiotic/synbiotic with placebo or a "standard care" control group. The incidence of postoperative infectious complications was analyzed. Fourteen RCTs involving 1566 patients (502 receiving probiotics, 273 receiving synbiotics, and 791 receiving placebo) were analyzed. Overall, probiotic or synbiotic administration significantly reduced the risk of developing postoperative infectious complications by 37% (relative risk (RR) = 0.63, 95% confidence interval (CI) 0.54-0.74, p < 0.001). Furthermore, when considering the six different types of postoperative infectious complications (septicemia, incision infection, central line infection, pneumonia infection, urinary infection, and incidence of diarrhea), probiotic or synbiotic administration was beneficial in reducing the incidence of each one of them. The quality of evidence was listed below: incidence of diarrhea (high), septicemia (moderate), incision infection (moderate), pneumonia infection (moderate), urinary infection (moderate), and central line infection (low). However, for the main outcome of infectious complications, we found evidence of possible publication bias, although estimates still showed a reduction following trim-and-fill analysis (RR = 0.72, 95% CI 0.62-0.84, p < 0.001). The use of probiotic/synbiotic supplementation is associated with a significant reduction in the risk of developing postoperative infectious complications in patients who had surgery for colorectal cancer. Additional studies are needed to confirm the findings due to publication bias and low quality of evidence.

Splenectomy perspective for non-malignant hematological disorders: A cross-sectional study in the Eastern Province of KSA

ObjectivesSplenectomy is considered a therapeutic modality for several hematological diseases, although complications are possible. This study assessed the effects of splenectomy on various hematological disorders and the roles of prophylactic measures on postoperative outcomes. MethodsThis was a cross-sectional study performed in KSA on adult patients with underlying non-malignant hematological disorders who had undergone splenectomy. ResultsThis study examined 179 patients with various hematological disorders, 38 (21.1%) of whom had undergone a splenectomy. Of those 38 patients, more than two-thirds (73.7%) had an open splenectomy. The average hospital stay was 2–7 days, and no significant difference was observed between the open and laparoscopic approaches. Approximately 95% of the patients showed overall improvements in their condition after splenectomy. However, 26.3% of patients reported a recurrence or need for further treatment 1 year or more after splenectomy. Approximately 16% of patients had an increased incidence of postoperative infectious complications, particularly patients with sickle cell disease and beta thalassemia. More than half the patients who developed complications had not received vaccination preoperatively, whereas 44.4% of vaccinated patients experienced complications (p = 0.04). ConclusionSplenectomy is considered a universal line of treatment for most non-malignant hematological diseases. Although splenectomy is an effective treatment, the reasons why patients with the same disease can have different responses remains unclear. Infection is a common postoperative complication, and vaccinations are underused. This study emphasizes the roles of patient education, scheduled vaccinations and proper selection of patients in the use of splenectomy for the treatment of non-malignant hematological diseases.

Bactibilia-effect on postoperative course and outcome in patients with bilio-pancreatic diseases

Background: Bactibilia is detrimental to the outcomes of biliary tract surgery. The present study was undertaken to determine the microbial flora of bile and their significance to post-operative infectious complications and morbidity.Methods: A retrospective study of patients with biliopancreatic diseases who underwent surgery from Jan 2017 to March 2020 in a tertiary care hospital were analyzed. The samples were assessed for bile microbiological flora, and a search for their possible link with post-operative infectious complications and morbidity was carried out.Results: A total of 90 bile samples were assessed. The mean age of the study group was 51.8 SD-13.6 years with male predominance. Bactibilia was found in 39 cases (43.3%), mostly in patients with malignant diseases, older than 50 years and females. Escherichia coli was the most common organism. Post-operative infectious complications were seen in twenty cases, thirteen of them in bactibilia-associated patients, showing statistical significance. Statistical significance was found between the presence of pre-operative biliary stent and bactibilia and between diabetes mellitus and bactibilia. Nine out of 24 patients with comorbidities had post-operative infectious complications. No significant relationship was found between pre-operative jaundice and comorbidities with bactibilia. Conclusions: The present study showed a statistically significant relationship between the presence of pre-operative biliary stent and bactibilia and also the incidence of post-operative infectious complications and bactibilia. Microbiological analysis of bile is a valuable tool in prognosticating the post-operative complications, thereby guiding us to provide adequate therapy and helps to establish local antibiotic guidelines.

Perioperative Use of Glucocorticoids and Intraoperative Hypotension May Affect the Incidence of Postoperative Infection in Patients with Gastric Cancer: A Retrospective Cohort Study.

BackgroundIn patients undergoing surgical resection for gastric cancer, postoperative complications—in particular, postoperative infections—remain an important problem and can result in delayed recovery and increased postoperative mortality.ObjectiveTo investigate the association between perioperative anesthesia management and postoperative infectious complications in patients undergoing resection for gastric cancer.DesignRetrospective cohort study.SettingA single-center study performed from April 1, 2015, to June 30, 2018, at Peking University Cancer Hospital.PatientsPatients who underwent resection for gastric cancer.Main Outcome MeasuresDemographic information, perioperative data (including anesthesia-related data, surgery-related data, and cancer diagnosis), and information on postoperative recovery were recorded. The primary outcome was incidence of postoperative infection; the secondary outcome was length of hospital stay. The associations between perioperative factors and postoperative infectious complications were analyzed using multivariable logistic regression models and the classification tree method.ResultsA total of 880 patients were included in the study; of these, 111 (12.6%) had postoperative infectious complications during hospitalization, including 78 surgical site infections and 62 remote infections. After correction for confounding factors on logistic multivariable analysis, perioperative use of glucocorticoids was associated with a lower incidence of postoperative infection (hazard ratio 0.968, 95% confidence interval 0.939 to 0.997, P=0.029), and intraoperative systolic blood pressure <90 mmHg for >10 min was associated with a higher incidence of postoperative infection (hazard ratio 2.112, 95% confidence interval 1.174 to 3.801, P=0.013). In addition, older age, preoperative hypoproteinemia, and total gastrectomy were identified as independent predictors of postoperative infection.ConclusionFor patients with gastric cancer, perioperative use of glucocorticoids and avoiding intraoperative hypotension may decrease the incidence of postoperative infectious complications.

A COMPARATIVE STUDY TO ASSESS THE NEED OF PROPHYLACTIC ANTIBIOTICS IN EARLY INFECTIVE COMPLICATIONS OF LOW RISK ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY

Background And Objectives: Elective laparoscopic cholecystectomy has a low risk for infectious complications, but many surgeons still use prophylactic antibiotics. The aim of this study was to investigate the necessity and rationale for giving prophylactic antibiotics in early infective complications in low-risk laparoscopic cholecystectomy. Study Design: Low-risk patients were randomly placed into 2 groups: 70 patients (group A ) did not receive any prophylactic antibiotic and 70 patients (group B) received 1 g Ceftriaxone intravenously at the time of induction of anaesthesia. In both groups, incidence of infective complications were recorded and compared. Results: In group A, there were 3 cases of post operative fever and 1 case of wound infection, while there were no cases of pulmonary infections and urinary tract infection. In group B, there were 2 cases of post operative fever and 1 case of wound infection, while there were no case of pulmonary infections and urinary tract infection. No signicant difference existed in the incidence of complications between the groups. Prolonged duration of surgery and Bile or Stone spillage were statistically signicant risk factors in determining post operative infective complications. Conclusions: Use of prophylactic antibiotic does not affect the already low incidence of postoperative infective complications and surgical site infections. Hence, prophylactic antibiotic is not necessary in low-risk elective laparoscopic cholecystectomy

Значение саркопении в развитии послеоперационных осложнений у пациентов, перенесших резекционные вмешательства на поджелудочной железе

The aim of the research. To evaluate the effect of sarcopenia on the incidence of postoperative complications in patients who underwent resection interventions on the pancreas, as well as the development of a simple clinical diagnosis of sarcopenia. Material and methods. Th e study included 109 patients, including 59 (54.1 %) men and 50 (45.9 %) women. All patients included in the study were operated on with subsequent morphological examination of the removed preparations. Diagnosis of the presence of sarcopenia in a patient was carried out using computed tomography (CT) and calculating the musculoskeletal index. Also, all patients underwent calculation of the psoas major muscle index (IBPM) equal to the ratio of the area of the psoas major muscle on one side to the square of the patient’s height. Th e patients were divided into two groups. The control group (68 patients) included patients without sarcopenia. The main group consisted of 41 patients who were diagnosed with sarcopenia. Results. Among patients in the compared groups, there were no statistically signifi cant diff erences in age, sex, ASA score and body mass index. Th ere was no statistically signifi cant diff erence in the incidence of major complications (Clavien-Dindo III / IV) (p = 0.2), however, the incidence of postoperative infectious complications was signifi cantly higher in patients from the study group compared to the control group (63.4 % versus 39.7 %, respectively, p = 0.01), as well as the incidence of postoperative clinically signifi cant pancreatic fi stulas (36.6 % versus 17.6 %, respectively, p = 0.02), as well as mortality (9.8 % versus 1.5 %, respectively, p = 0.04). The average postoperative bed-day was 19.9±7.8 days in the main group, 14.2±5.1 days in the control group (p = 0.03). According to the study, the value of IBP in the diagnosis of sarcopenia is &lt; 3,5 сm2 /м2 (AUC – 0,83) for men and &lt; 2,7 сm2 /м2 (AUC – 0,87) for women. Conclusion. Sarcopenia is associated with a higher incidence of postoperative infectious complications, clinically signifi cant pancreatic fi stulas, mortality, as well as with a longer postoperative bed-day in patients who underwent resection of the pancreas

Predictive Value of Sarcopenia on Postoperative Outcomes after Pancreas Resection

Purpose: Pancreatic surgery is a complex procedure that requires a high level of expertise, up to 40% of patients develop complications following pancreatic resection. However, predicting patients at high risk of complications is a complex clinical problem. Aims: To evaluate the effect of sarcopenia on the incidence of postoperative complications (PC) in patients who underwent PR and to develop a new method for prediction the risk of PC after PR. Method: 109 consecutive patients (59 men, 50 women) who underwent PR (pancreaticoduodenectomy , distal or central resection). We used segmentation of computed tomography (CT) images to quantify skeletal muscle mass and diagnose sarcopenia (SP). On the same CT image the index of the psoas major muscle (IPMM) was calculated equal to the ratio of the area of the PMM to the square of the patient's height. The patients were divided in control group (68 patients) - patients without SP. The main group 41 patients who were diagnosed with SP. Results: Among patients in the compared groups, there were no statistically significant differences in age, sex, ASA score and body mass index. There was no statistically significant difference in the incidence of major complications (Clavien - Dindo III / IV) (p = 0.2), however, the incidence of postoperative infectious complications was significantly higher in patients from the main group compared to the control group (63.4% versus 39 , 7%, respectively, p = 0.01), as well as the incidence of postoperative clinically relevant pancreatic fistula (36.6% versus 17.6%, respectively, p = 0.02), as well as mortality (9.8% versus 1.5%, respectively, p = 0.04). The average postoperative lengths of hospital stay was 19.9 ± 7.8 days in the main group, 14.2 ± 5.1 days in the control group (p = 0.03). According to the study, the value of IPMM in the diagnosis of sarcopenia is <3.5 cm2 / m2 (AUC - 0.83) for men and <2.7 cm2 / m2 (AUC - 0.87) for women. Conclusion: Sarcopenia is associated with a higher incidence of postoperative infectious complications, clinically relevant pancreatic fistulas, mortality, as well as with a longer postoperative lengths of hospital stay in patients who underwent resection of the pancreas.

The effects of intensive oral care before surgery for gastric cancer patients.

Oral function management has been recognized as important strategy for preventing postoperative complications. In this historical cohort study, we focused on the patients who planed gastrectomy, and investigated the appropriate duration and frequency of preoperative oral care to prevent complications after surgery. Patients who planed surgery for gastric cancer between 2012 and 2018 were enrolled. We defined intensive oral care (IOC) as initial intervention at least three weeks before surgery and follow-up intervention within a week before surgery. As the primary outcome, the incidence of postoperative infectious complications was compared between the IOC and non-intensive oral care groups. A total of 576 patients were enrolled, including 66 with IOC. The incidence of infectious complications was 2/66 (3.0%) in the IOC group and 64/510 (12.5%) in the non-intensive oral care group. After adjusting for confounding factors, patients with IOC exposure had a lower chance of developing postoperative infectious complications (odds ratio; 0.217, 0.051-0.927). Intensive oral care can help prevent postoperative infectious complications after gastrectomy. These findings suggest that appropriate preoperative oral care includes at least two interventions: three weeks or more before and within one week before surgery.

C-Reactive Protein as a Diagnostic Tool for Infectious Complications&#x0D; and Esophagojejunal Anastomotic Leakage after Gastrectomy

Introduction. The tendency to the wide implementation of the enhanced recovery after surgery (ERAS) protocol in the clinical practice leads to the increased requirement in surgical safety that can be provided with the possible earliest detection of postoperative complications and appropriate treatment. This requirement is the most acute in gastric cancer surgery, where despite the improvement of surgical techniques and complex treatment approach the rate of postoperative complications and esophagojejunal anastomotic leakage (EAL) is still high, making up 27% and 10%, respectively. The measurement of C-reactive protein (CRP) concentration in blood plasma is the simplest, most accessible and reliable method to detect infectious complications. However, CRP concentrations, which may indicate the development of postoperative complications, differ significantly in different studies.The aim of the study was to specify the role of CRP as a predictive biomarker for infectious complications and esophagojejunal anastomotic leakage.Materials and methods. This retrospective study included immediate outcomes of the planned radical gastrectomy in 130 patients. The CRP level was assessed depending on the complication type in the immediate postoperative period. Correlation between CRP levels and the incidence of postoperative infectious complications was analyzed. The severity grade of postoperative complications was registered according to the modified Clavien-Dindo classification. The statistical analysis was performed using parametrical and non-parametrical methods. The optimal cut-off CRP for infectious complications and anastomotic leakage was defined with the use of the ROC analysis. The multifactorial ANOVA was performed to detect the effect of contributing factors on the CRP level.Results. An increase in CRP levels over 100 mg/L on the fourth day after surgery can be considered as a manifestation of infectious complications (AUC 0,866 0,042, 95% CI: 0,798-0,934, p 0,001), and an increase in CRP levels over 167 mg/L on the fifth day is a predictor of the development of EAL (AUC 0,869 0,081, 95% CI: 0,711-1,000, p = 0,001). Initial malnutrition and aggravated somatic status appear to be risk factors for the development of infectious complications (p 0,001).Conclusion. Therefore, despite its low specificity, CRP is a sensitive marker of postoperative infectious complications starting from the first days of the postoperative period. Evaluation of the CRP concentration in dynamics allows identifying postoperative complications before the development of clinical manifestations.

Clinical importance of "occult-bacterial translocation" in patients undergoing highly invasive gastrointestinal surgery: A review.

In the clinical setting, mild bacteremia cannot be detected by conventional culture methods, only by a highly sensitive bacterial detection system. One of the major causes of mild bacteremia is bacterial translocation (BT) induced by a dysregulated intestinal microenvironment and increased intestinal epithelial permeability. This condition is called "occult-bacterial translocation (O-BT)"; however, the concept of O-BT is not yet fully recognized. In our previous studies, done using a highly sensitive bacterial detection system such as bacterium-specific ribosomal RNA-targeted reverse transcriptase quantitative polymerase chain reaction (RT-qPCR), O-BT was commonly observed in patients who underwent highly invasive surgery. We collected blood and mesenteric lymph node (MLN) samples from patients undergoing esophagectomy for esophageal cancer, before and after they were subjected to surgical stress. The detection rate of bacteria in these samples increased from approximately 20% before surgical stress to more than 50% after surgical stress. Moreover, positivity for bacteria in the blood or MLN samples was associated with the incidence of postoperative infectious complications (POICs). Using the RT-qPCR system, it is possible to detect the specific bacteria that cause O-BT immediately after surgery. This may allow us to select the exact antibiotic that targets possible pathogenic bacteria of POICs.

Preoperative cholangitis is associated with increased surgical site infection following pancreaticoduodenectomy.

Few reports describe the relationship between preoperative cholangitis and surgical site infections (SSIs) after pancreaticoduodenectomy (PD). We aimed to determine the association between the incidence of preoperative cholangitis and surgical site infection following PD. The surgical outcomes of 359 patients who underwent PD were compared between patients with (n=92) and without (n=267) preoperative cholangitis. Bacterial cultures from the postoperative drainage fluid were examined. Risk factors for postoperative infectious complication were evaluated. The incidence of postoperative infectious complications including grade B/C postoperative pancreatic fistula was high among patients with preoperative cholangitis (P<.01). The positive rate of bacterial culture in the drainage fluid until postoperative day 3 (P<.01) and the detection rate of Enterococcus species (P<.01) were higher in the preoperative cholangitis group. The most common cause of preoperative cholangitis was drainage device dysfunction mainly with plastic stent occlusion. In the multivariate analysis, preoperative cholangitis (odds ratio 2.04, 95% confidence interval 1.13 to 3.69; P=.02) was an independent risk factor for postoperative infectious complications. Preoperative cholangitis significantly increased ascitic bacterial contamination and the incidence of postoperative infectious complications. after PD. Appropriate preoperative biliary drainage for the prevention of preoperative cholangitis is important for improving outcomes after PD.

The Impact of Severe Infectious Complications on Long-term Prognosis for Gastric Cancer.

The aim of this study was to evaluate the impact of postoperative infectious complications on long-term outcomes after curative resection of gastric cancer. Patients who underwent curative gastrectomy with lymphadenectomy for gastric cancer at Yokohama City University and Kanagawa Cancer Center from January 2000 to August 2015 were retrospectively selected from medical records. Clinicopathological factors between patients with and without infectious complications were compared. Prognostic factors of long-term survival were analyzed by univariate and multivariate Cox proportional hazards analyses. A total of 2,254 patients were eligible for inclusion in the present study. Fifty-eight patients had postoperative infectious complications (IC group); 2,196 had no postoperative infectious complications (NC group). In the IC group, the median age (p=0.031), body mass index (p=0.004), American Society of Anesthesiologists physical status (p=0.006) and percentage of male patients (p<0.001) were higher in comparison to the NC group. The operation time was longer (p<0.001) and the incidence of intestinal-type histology was higher (p=0.017) in the IC group. The 5-year overall survival rates of the IC and NC groups were 59.8% and 83.2%, respectively (p<0.001). Univariate and multivariate analyses demonstrated that postoperative infectious complications were a significant risk factor for poorer overall survival (hazard ratio=2.38; 95% confidence interval=1.47-3.85, p<0.001). Perioperative management is necessary to reduce the incidence of postoperative infectious complications and improve the survival of patients after curative resection of gastric cancer.

Impact of Qualitative and Quantitative Biliary Contamination Status on the Incidence of Postoperative Infection Complications in Patients Undergoing Pancreatoduodenectomy.

Bacterial contamination status may differ under different biliary drainage conditions. The purpose of this study was to determine the impact of qualitative and quantitative biliary bacterial contamination on the incidence of infection complications in patients undergoing pancreatoduodenectomy. Patients undergoing pancreatoduodenectomy for periampullary diseases with different biliary drainage conditions, such as external drainage (ED), internal drainage (ID), and no drainage (ND), were included. Bile was collected intraoperatively, and biliary contamination status was qualified and quantified using bacterium-specific ribosomal RNA-targeted reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The impact of biliary contamination status on infection complications was analyzed. A total of 152 patients were included (38 with ED, 40 with ID, and 74 with ND). The positive rate of microorganisms in bile was higher in the ID group (98%) compared with the ED group (82%, p = 0.021) and the ND group (65%, p < 0.001). The number of microorganisms detected in bile samples was higher in the ID group compared with the ED group (median 489,788 vs. 5375 bacteria/mL of bile, p < 0.001). With multivariate analysis, soft pancreas, intraoperative bleeding (> 600mL), and biliary contamination by Atopobium cluster were identified as independent risk factors for infection complications. Biliary contamination by Atopobium cluster was significantly higher in the ID group compared with the other groups. Biliary bacterial contamination is more frequently induced by ID than either ED or ND. In addition to the previously known risk factors, biliary contamination with Atopobium cluster may be one of the risk factors of infection complications following pancreatoduodenectomy.