Rate Of Postoperative Infectious Complications Research Articles

Tubeless ureteroenteric anastomosis in robot-assisted radical cystectomy with intracorporeal urinary diversion does not increase the risk of anastomotic stenosis or postoperative complications.

The objective is to demonstrate that omitting ureteral stent placement in robotic intracorporeal urinary diversion does not lead to increased risk of perioperative complications, namely ureteral strictures or anastomotic leaks. We retrospectively reviewed the records of 68 consecutive patients who underwent robotic radical cystectomy with ileal conduit creation or orthotopic neobladder by a single surgeon between January 2020 and September 2023. Chronologically, the first cohort of patients had ureteral stents placed to bridge the ureteroenteric anastomosis, and in the second cohort, stenting was omitted. Cohort 1 consisted of 28 patients with surgeries performed between January 2020 and April 2021, while cohort 2 had 40 patients who underwent surgery from April 2021 to September 2023. The cohorts were well matched with regard to patient age, gender, ASA score and rate of neoadjuvant chemotherapy. The choice of urinary diversion was left to surgeon and patient preference, and there was no significant difference in the proportion of ileal conduits versus orthotopic neobladders within each cohort. Estimated blood loss, total operative time, inpatient length of stay and pathologic T and N staging did not statistically differ between the cohorts. Overall, there was no difference in the rates of postoperative ileus, ureteral stricture, anastomotic leak, infectious complications, and 30-day readmission rates between the groups. Tubeless ureteroenteric anastomosis in patients undergoing robotic radical cystectomy with intracorporeal diversion does not appear to increase the risk of anastomotic strictures or postoperative complications. Further prospective evaluation is warranted.

Perioperative Antibiotic Choice and Postoperative Infectious Complications in Pelvic Organ Prolapse Surgery

ObjectiveThe objective of this study was to determine how rates of postoperative infectious complications after pelvic organ prolapse surgery differ based on perioperative antibiotic administered. In particular, we sought to determine whether anaerobic coverage is associated with reduced rates of infectious complications. DesignThis was a retrospective cohort study. SettingPremier Healthcare U.S. national database, a comprehensive all-payer dataset capturing patients from urban and rural nonprofit, community, and teaching hospitals. ParticipantsAdult patients who underwent vaginal, laparoscopic, and/or abdominal prolapse surgery with or without hysterectomy from January 2000 to March 2020. Procedures with and without mesh were included. InterventionsRates of infectious complications were compared among patients who received guideline-concordant antibiotic regimens, including those with anaerobic coverage. The primary outcome was any surgical site infection within 30 days of surgery without mesh or 90 days of surgery involving mesh. ResultsAmong 130,198 prolapse surgeries, the most common antibiotic regimens were cefazolin (n = 97,058, 74.5%), second-generation cephalosporin (n = 16,442, 12.6%), clindamycin + aminoglycoside (n = 8,397, 6.4%) and cefazolin + metronidazole (n = 4,328, 3.3%). On multivariable logistic regression, only clindamycin + aminoglycoside was associated with a higher rate of surgical site infections (OR = 1.37; 95% CI 1.09–1.72) and other infectious morbidity (OR = 1.26; 95% CI 1.12–1.42) when compared to cefazolin alone. The addition of metronidazole to cefazolin was not associated with reduced rates of surgical site infections (OR = 1.09; 95% CI 0.82–1.45). Obesity (OR = 1.22; 95% CI 1.03–1.43), diabetes without complication (OR = 1.30; 95% CI 1.08–1.57), Charlson comorbidity score >0 (OR = 1.24; 95% CI 1.06–1.45), and tobacco use (OR = 1.22, 95% CI 1.05–1.40) were also associated with increased composite surgical site infection. ConclusionCompared with cefazolin alone, the use of alternative perioperative antibiotics, including those with anaerobic coverage, was not associated with reduced infectious complications after pelvic organ prolapse surgery in this U.S. national sample.

Risk factors of early infectious complications after ureterorenoscopy for stone disease: a prospective study.

To prospectively evaluate the rate and associated risk factors of early infectious complications after ureterorenoscopy for urolithiasis. After ethical committee approval, 400 therapeutic retrograde ureterorenoscopy procedures between August 3, 2020 and November 24, 2021 were included for analysis in a single-center study. Postoperative infection was defined as an afebrile urinary tract infection, fever (≥ 38°C) with pyuria (≥ 300WBC/μL) or proven urinary pathogen, and urosepsis. The primary outcome was the rate of infectious complications after ureterorenoscopy. Secondary outcomes were the perioperative factors that increased the risk of infectious complications within 30days of surgery using univariate and multivariate logistic regression analysis. Twenty-nine of four hundred (7.3%) patients developed an infectious complication within 30days after ureterorenoscopy. Ten (2.5%) patients developed an afebrile urinary tract infection, eight (2.0%) developed fever with pyuria, five (1.3%) febrile urinary tract infection, and six (1.5%) urosepsis. On univariate analysis, preoperative stent-type JFil® pigtail suture stent was significantly associated with the dependent variable (p < 0.001). On multivariate logistic regression analysis, older age (OR 1.035; 95% CI 1.006-1.070; p = 0.02) was found to be significantly associated with developing a postoperative infectious complication. A 7.3% rate of postoperative infectious complications and 1.5% urosepsis rate were observed after therapeutic ureterorenoscopy, without the need of intensive care admission. The only significant risk factors were preoperative stent type (JFil® pigtail suture stent) on univariate analysis, and older age on multivariate logistic regression analysis. Further multicentric prospective observational data are needed in this field.

Eyeing Risks: A Critical Analysis of the Use of Periorbital Steroids in Fronto-orbital Advancement.

To evaluate the outcomes associated with two techniques of periorbital steroid administration in bilateral fronto-orbital advancement (FOA). Multi-institutional retrospective chart review. Two high volume, tertiary US craniofacial centers. Patients who underwent FOA between 2012 and 2021. Patients were divided into three cohorts based on method of steroid administration. Groups GEL and INJ represent those who received steroids in the form of triamcinolone soaked gelfoam or direct injection of dilute triamcinolone to the frontal/periorbital region, respectively. Group NON did not receive any periorbital steroids. Peri-operative outcomes including hospital length of stay and complications were evaluated based on method of periorbital steroid administration. Variables predictive of infectious complications were assessed using stepwise logistic regression. Four hundred and twelve patients were included in our sample (INJ:249, GEL:87, NON:76). Patients in the INJ group had a higher ASA class (P < .001) while patients in the NON group were significantly more likely to be syndromic (P < .001) and have multisuture craniosynostosis (P < .001). Rate of infectious complications for each cohort were NON: 2.6%, INJ: 4.4%, and GEL: 10.3%. There was no significant difference between groups in hospital length of stay (P = .654) or rate of post-operative infectious complications (P = .061). Increased ASA class (P = .021), increased length of stay (P = .016), and increased intraoperative narcotics (P = .011) were independent predictors of infectious complications. We identified a dose-dependent relationship between periorbital steroids and rate of postoperative infections, with key contributions from ASA class, hospital length of stay, and dose of intraoperative narcotics.

Vacuum-assisted mini-percutaneous nephrolithotomy is associated with lower rates of infectious complications compared to vacuum-cleaner procedure in patients at high risk for infections: a single-center experience

PurposeTo evaluate the impact of vacuum-assisted mini-percutaneous nephrolithotomy (vamPCNL) vs. vacuum-cleaner mPCNL (vcmPCNL) on the rate of postoperative infectious complications in a cohort of patients with high risk factors for infections.MethodsWe retrospectively analysed data from 145 patients who underwent mPCNL between 01/2016 and 12/2022. Patient’s demographics, stones characteristics and operative data were collected. vamPCNL and vcmPCNL were performed based on the surgeon’s preference. High-risk patients were defied as having ≥ 2 predisposing factors for infections such as a history of previous urinary tract infections, positive urine culture before surgery, stone diameter ≥ 3 cm, diabetes mellitus and hydronephrosis. Complications were graded according to modified Clavien classification. Descriptive statistics and logistic regression models were used to identify factors associated with postoperative infectious complications.ResultsvamPCNL and vcmPCNL were performed in 94 (64.8%) and 51 (35.2%) cases, respectively. After surgery, infectious complications occurred in 43 (29.7%) participants. Patients who developed infectious complications had larger stone volume (p = 0.02) and higher rate of multiple stones (p = 0.01) than those who did not. Infectious complications occurred more frequently after vcmPCNL than vamPCNL (55.9% vs. 44.1%. p = 0.01) in high-risk patients. Longer operative time (p < 0.01) and length of stay (p < 0.01) were observed in cases with infectious complications. At multivariable logistic regression analysis, longer operative time (OR 1.1, p = 0.02) and vcmPCNL (OR 3.1, p = 0.03) procedures were independently associated with the risk of infectious complications post mPCNL, after accounting for stone volume.ConclusionOne out of three high-risk patients showed infectious complications after mPCNL. vamPCL and shorter operative time were independent protective factors for infections after surgery.

Risk Factors of Infectious Complications in Pediatric Patients With Cerebral Palsy After Spinal Arthrodesis.

This was a retrospective study. The main objective of this study was to investigate (1) whether pediatric patients with cerebral palsy (CP) have higher rates of postoperative infectious complications after spinal fusion and (2) risk factors for postoperative infections. Prior studies have shown that patients with CP undergo corrective spine surgery more often than the general population, yet typically have worse postoperative outcomes. Further investigation is needed to improve our understanding of the perioperative factors that place children with CP at greater risk of postoperative infectious complications. The 2019 "American College of Surgeons National Surgical Quality Improvement Program" Pediatric database was used for patient data. The univariable analysis compared the prevalence of preoperative comorbidities and perioperative factors between children with and without CP. Multivariable logistic regression modeling was used to ascertain independent risk factors for postoperative infectious complications. A total of 4445 patients were included in the study; 606 (13.63%) patients had CP and 3839 (86.37%) did not. Patients with CP were more likely to have several notable preoperative comorbidities, and the rate of developing any infectious complication was more than 7 times greater in the CP cohort than in the control cohort (14.36% vs 1.88%; P <0.001). Multivariable analysis revealed CP [odds ratio (OR): 3.55, CI: 2.25-5.60; P <0.001], American Society of Anesthesiologists class 3 or higher (OR: 2.10, CI: 1.29-3.42; P = 0.003), and hematologic disorders (OR: 2.01, CI: 1.06-3.83; P = 0.033) to be independent risk factors for increased postoperative infectious complications. CP is an independent risk factor for the development of 30-day postoperative infectious complications in pediatric patients. In addition, the American Society of Anesthesiologists class 3 or higher and hematologic disorders were risk factors for postoperative infections after spinal fusion surgery.

Understanding the Role of Ureteral Access Sheath in Preventing Post-Operative Infectious Complications in Stone Patients Treated with Ureteroscopy and Ho:YAG Laser Lithotripsy: Results from a Tertiary Care Referral Center.

The use of ureteral access sheaths (UAS) limits the irrigation-induced increase in intrarenal pressure during ureteroscopy (URS). We investigated the relationship between UAS and rates of postoperative infectious complications in stone patients treated with URS. Data from 369 stone patients treated with URS from September 2016 to December 2021 at a single institution were analyzed. UAS (10/12 Fr) placement was attempted in case of intrarenal surgery. The chi-square test was used to assess the relationship between the use of UAS and fever, sepsis, and septic shock. Univariable and multivariable logistic regression analyses tested the association of patients' characteristics and operative data and the rate of postoperative infectious complications. Full data collection of 451 URS procedures was available. Overall, UAS was used in 220 (48.8%) procedures. As for postoperative infectious sequalae, we recorded fever (n = 52; 11.5%), sepsis (n = 10; 2.2%), and septic shock (n = 6; 1.3%). Of those, UAS was not used in 29 (55.8%), 7 (70%), and 5 (83.3%) cases, respectively (all p > 0.05). At multivariable logistic regression analysis, performing URS without UAS was not associated with the risk of having fever and sepsis, but it increased the risk of septic shock (OR = 14.6; 95% CI = 1.08-197.1). Moreover, age-adjusted CCI score (for fever-OR = 1.23; 95% CI = 1.07-1.42, sepsis-OR = 1.47; 95% CI = 1.09-1.99, and septic shock-OR = 1.61; 95% CI = 1.08-2.42, respectively), history of fever secondary to stones (for fever-OR = 2.23; 95% CI = 1.02-4.90) and preoperative positive urine culture (for sepsis-OR = 4.87; 95% CI = 1.12-21.25) did emerge as further associated risk factors. The use of UAS emerged to prevent the onset of septic shock in patients treated with URS, with no clear benefit in terms of fever and sepsis. Further studies may help clarify whether the reduction in fluid reabsorption load mediated by UAS is protective against life-threatening conditions in case of infectious complications. The patients' baseline characteristics remain the main predictors of infectious sequelae in a clinical setting.

Perioperative intravenous dexamethasone for patients undergoing colorectal surgery: a systematic review and meta-analysis.

Dexamethasone is a glucocorticoid that is often administered intraoperatively as prophylaxis for postoperative nausea and vomiting (PONV). Several randomized controlled trials (RCTs) have examined its use in colorectal surgery. This systematic review aims to assess the postoperative impacts of dexamethasone use in colorectal surgery. MEDLINE, Embase, and CENTRAL were searched from database inception to January 2023. Articles were included if they compared perioperative intravenous dexamethasone to a control group in patients undergoing elective colorectal surgery in terms of postoperative morbidity. The primary outcomes were prolonged postoperative ileus (PPOI) and PONV. Secondary outcomes included postoperative infectious morbidity and return of bowel function. A pair-wise meta-analysis and GRADE assessment of the quality of evidence were performed. After reviewing 3476 relevant citations, seven articles (five RCTs, two retrospective cohorts) met the inclusion criteria. Overall, 1568 patients received perioperative dexamethasone and 1459 patients received a control. Patients receiving perioperative dexamethasone experienced significantly less PPOI based on moderate-quality evidence (three studies, OR 0.46, 95%CI 0.28-0.74, p < 0.01). Time to first flatus was significantly reduced with intravenous dexamethasone. There was no difference between groups in terms of PONV (four studies, OR 0.90, 95%CI 0.64-1.27, p = 0.55), postoperative morbidity (OR 0.93, 95%CI 0.63-1.39, p = 0.74), or rate of postoperative infectious complications (seven studies, OR 0.74, 95%CI 0.55-1.01, p = 0.06). This review presents moderate-quality evidence that perioperative intravenous dexamethasone may reduce PPOI and enhance the return of bowel function following elective colorectal surgery. There was no significant observed effect on PONV or postoperative infectious complications.

Impact of Extended Antibiotic Use After Pancreaticoduodenectomy for Patients with Preoperative Metallic Biliary Stenting Treated with Neoadjuvant Chemotherapy

IntroductionPancreaticoduodenectomy (PD) remains a complex surgical procedure with infectious complications affecting nearly 50% of patients. Patients who undergo biliary drainage with stent placement prior to neoadjuvant treatment (NAT) reportedly have higher infection rates following PD. The aim of the current study is to evaluate the differences in postoperative infectious complication rates based on the duration of post operative prophylactic antibiotics in patients with indwelling metal biliary stent who had NAT. MethodsA retrospective institutional pancreatic cancer database was queried for patients who had a metal biliary stent placed prior to NAT initiation, followed by subsequent PD between 2014 and 2021. Duration of postoperative prophylactic antibiotics was defined as short (SC: ≤ 24 h) or extended (EC: > 24 h–7 days). The primary outcome of interest was surgical site infection (SSI). ResultsTwo hundred and ninety-five (n = 295) patients were identified of which the majority (n = 205, 69.5%) received a short course of antibiotics postoperatively. Baseline characteristics were similar between the two cohorts including age, sex, BMI, and comorbidity index. EC patients received more NAT cycles (4 vs. 3, p < 0.001) and underwent an open PD more frequently (61.8% vs. 41.0%, p < 0.001). SSI occurred in 64 (21.7%) patients; SC cohort: 54, 26.3% vs. EC cohort:10, 11.1%, (p = 0.003). Additionally, the SC cohort demonstrated a higher incidence of major complications (Clavien-Dindo ≥ 3: 51 [24.9%] vs. 13 [14.4%], p = 0.045). On the logistic regression model examining factors associated with SSI, higher BMI (continuous variable) was associated with increased odds of SSI (OR: 1.05 [95%CI: 1.00, 1.10, p = 0.040), while EC was protective (OR: 0.36 [95%CI: 0.17, 0.75], p = 0.007). ConclusionsThese data suggest that an extended course of perioperative antibiotic correlates with reductions in SSI and major morbidity following PD in patients with a metallic biliary stent placed prior to NAT course. These results require validation in a future randomized clinical trial examining a larger cohort of patients with further emphasis on the types of perioperative antibiotics administered.

Selective Decontamination of the Digestive Tract in Pancreatic Head Resections-A Propensity Score-Matched Analysis.

(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.

Association of Post Operative Infectious Complications and Length of Hospital Stay with Duration of Surgeries

Background: Postoperative infectious complications which results in prolong hospital stay carries a significant risk to patients and burdanise health care system as well. Many risk factors are known to increase the incidence of post operative infectious complications and length of hospital stay. The aim of present study is to determine the association of time duration of surgeries with post operative infectious complications and length of hospital stay. Methodology: This prospective observational study was conducted on 462 patients who underwent various major surgical procedures in the Department of General Surgery in PIMS Hospital, Islamabad from January 2020 to December 2021. Patients &lt;16 years and admitted for trauma were excluded. The time duration of various surgeries from incision to closure was recorded. Post operative complications sepsis, pneumonia, wound infection, urinary tract infection and length of hospital stay was recorded as well. Data was analyzed by spss version 22 .Any Correlation between time duration of surgeries with post operative complications and length of hospital stay determined. Results: Of the total 462 patients who underwent various surgical procedures, the post operative infectious complication rate increased linearly with operation duration at 2.5% per ½ hours ranging from 2.5% to 30.6% in 1 hour to 6 hours respectively. Infectious complications such as UTI, wound infection, pneumonia, and sepsis showed positive correlation with time duration of surgeries. The post operative infectious complications increased after one hour of surgery compared to half hour. Conclusion: As the time duration of surgeries increase the chances of post operative infectious complications also increase, hence increasing the length of hospital stay as well. Keywords: Post operative infectious complications, Hospital stay, Duration of surgeries.

Evidence-based optimisation of empirical antibiotic regimens in paediatric complicated appendicitis: a retrospective study of 94 patients.

Acute appendicitis is the most frequent surgical emergency in the paediatric population. Complicated appendicitis accounts for 30% of cases and is inextricably linked to postoperative infectious complications. A study at our institution showed that amoxicillin-clavulanate resistant Escherichia coli in complicated appendicitis was significantly linked to postoperative infectious complications. These findings led to a change in the empirical antibiotic protocol (amoxicillin-clavulanate changed to ceftriaxone + metronidazole as of 2017), intending to reduce postoperative infectious complications in complicated appendicitis in our institution. This study aimed to analyse the microbiology and resistance profiles of pathogens of complicated appendicitis at our institution since implementing the new antibiotic protocol and the postoperative infectious complications rate. We designed a retrospective comparative cohort study. During the defined study period (01 January 2017 to 31 July 2020), medical records were analysed for cases of acute appendicitis, complicated appendicitis and postoperative infectious complications, retaining only those who fulfilled inclusion criteria. Postoperative outcomes, microbiology and antibiotic resistance of peritoneal swabs were analysed. During the study period, 95 patients presented with a complicated appendicitis, and 11 (12%) developed postoperative infectious complications. The most frequent pathogens found in complicated appendicitis were E. coli (66%), Streptococcus anginosus (45%), and Bacteroides fragilis (22%). Pseudomonas aeruginosa was present in 17% of complicated appendicitis. Pathogens involved in postoperative infectious complications mirrored the distribution found in complicated appendicitis without postoperative infectious complications. Antibiotic susceptibility analysis showed that 10 (15%) of E. coli strains were resistant to amoxicillin-clavulanate but sensitive to ceftriaxone + metronidazole, with only one strain responsible for causing a postoperative infectious complication. Six additional strains of E. coli (9%) were resistant to amoxicillin-clavulanate and our empirical antibiotic regimen but were not associated with an increase in postoperative infectious complications. Compared with our previous study, there was a decrease in postoperative infectious complications from 16% to 12%. Postoperative infectious complications caused by amoxicillin-clavulanate-resistant E. coli decreased from 28% to 9%. This retrospective study demonstrated a decrease in the rate of postoperative infectious complications due to amoxicillin-clavulanate-resistant E. coli in complicated appendicitis. These findings accentuate the need to implement evidence-based treatment protocols based on local microbiology profiles and resistance rates to optimise post-operative antibiotics in complicated appendicitis.

Blood Transfusion is Associated With Adverse Outcomes in Pediatric Solid Tumor Oncology Patients Following Tumor Resection.

Packed red blood cell (PRBC) transfusion is a lifesaving intervention that also has proinflammatory and immunosuppressive effects. Adults with a malignancy who receive PRBC transfusion have increased rates of infection, tumor recurrence, and decreased survival. The effect of PRBC transfusion among children with solid tumors is unknown. We performed a retrospective review of all children who underwent operative resection of a solid tumor malignancy. Data collected included demographic information, location of operation, nadir hemoglobin, and any PRBC transfusion within 30 days of tumor resection. Three hundred sixty children underwent tumor resection at our institution between 2002 and 2013; 194 (54%) received a perioperative blood transfusion. After adjusting for stage at diagnosis, tumor location, preoperative chemotherapy and nadir hemoglobin, blood transfusion was associated with a higher rate of postoperative infectious complications, shorter disease-free interval, and a higher rate of tumor recurrence. Each additional transfused unit increased the risk of postoperative infection (odds ratio 3.83; 95% confidence interval 1.21, 14.22, P =0.031). Among children with solid tumor malignancies, PRBC transfusion within 30 days of operation is associated with higher rates of postoperative infection. If transfusion becomes necessary, single unit increments should be transfused. Level III.

Less Severe Intra-Abdominal Infections in Robotic Surgery for Gastric Cancer Compared with Conventional Laparoscopic Surgery: A Propensity Score-matched Analysis.

The impact of robotic gastrectomy (RG) for gastric cancer (GC) on the incidence of postoperative complication is debatable and unclear. This study enrolled 200 patients with GC who were surgically treated and consisted of 100 RG and 100 laparoscopic gastrectomy (LG) cases using an ultrasonic scalpel. The short-term outcomes were compared between the two groups. These outcomes were compared using a 1:1 propensity score (PS)-matching analysis. After PS matching, 76 cases in each group were well matched. Mean surgical time was significantly longer in the RG group than in the LG group (393 vs. 342min, p<0.005), whereas mean blood loss during surgery was significantly lower in the RG group than in the LG group (30.1 vs. 50.1mL, p=0.023). The median number of surgeons who attend the main part of the surgery was significantly less in the RG group than in the LG group (2.0 vs. 3.0, p=0.01). The rate of severe intra-abdominal infectious complication was significantly lower in the RG group than in the LG group (0% vs. 9.2%, p=0.014). The duration from surgery to adjuvant chemotherapy was significantly shorter in the RG group than in the LG group (29.6±11.0 vs. 45.2±27.8days, p=0.046). RG using an ultrasonic scalpel may be a viable alternative to LG because of the improvement in the rate of postoperative intra-abdominal infectious complications after curative surgery for GC.

TP7.2.16 Systematic review and meta analysis of pre operative antibiotics and bowel preparation on ileus following colorectal resection

Abstract Aims Pre-operative oral antibiotics (OAB) and mechanical bowel preparation (MBP) may reduce rates of post-operative infectious complications following colorectal surgery but their effects on post-operative ileus (POI) are not well-established. We conducted a systematic review and meta-analysis to address this question. Methods Medline and Embase databases were searched to identify randomised controlled trials and cohort studies comparing pre-operative MBP or OAB to control in patients undergoing elective colorectal resection and reporting the rate of POI as an outcome. Risk ratios were pooled using a random-effects model to generate a summary risk ratio and 95% confidence interval. Results Five randomised trials and three cohort studies were included which reported the effect of pre-operative MBP on POI. Some 29056 patients received MBP compared to 13077 who did not. The rates of POI were 10.0% vs 12.0% respectively. Meta-analysis gave a risk ratio of 0.85 (0.80-0.91, p &amp;lt; 0.0001) for the development of POI with MBP versus control. Four randomised trials and four cohort studies were included which reported the effect of pre-operative OAB on POI. Some 9.5% of 19,903 patients receiving OAB developed POI compared to 11.8% of 23,884 control patients. The pooled risk ratio for the development of POI with OAB compared to control was 0.86 (0.81-0.91, p &amp;lt; 0.0001). However, when limiting analyses to randomised trials alone, neither MBP (RR 1.13, 0.67-1.90) nor OAB 1.01, 0.75-1.35) had a significant effect on the rate of POI. Conclusions Pre-operative MBP or OAB may reduce POI following colorectal resection but this has not been confirmed in randomised trials.

Vaginal preparation with povidone-iodine or chlorhexidine before hysterectomy: a propensity score matched analysis

Antiseptic vaginal preparation is recommended before gynecologic surgery; however, there is a lack of data regarding the effectiveness of different agents. To compare rates of postoperative infectious complications and hospital utilization with preoperative vaginal preparation using povidone-iodine or chlorhexidine before hysterectomy. This was a retrospective analysis of patients who underwent hysterectomy for gynecologic indications at 70 hospitals in a statewide surgical collaborative between January 2017 and December 2019. The primary outcome was postoperative infectious complications (including urinary tract infection, surgical site infections involving superficial, deep, or organ space tissues, or cellulitis) within 30 days of surgery. To adjust for confounding, propensity score matching, 1:1 without replacement and with a caliper of.005 was performed to create cohorts that had vaginal preparation with either povidone-iodine or chlorhexidine and did not differ in observable characteristics. We compared the rates of infectious morbidity and hospital utilization (emergency department visits, readmission, reoperation) in the matched cohorts. In the statewide collaborative, there were 18,184 patients who received povidone-iodine and 3018 who received chlorhexidine. After propensity score matching of 2935 pairs, the povidone-iodine and chlorhexidine groups did not differ in demographics, comorbidities, choice of preoperative antibiotics, benign vs malignant surgical indication, and surgical approach. Povidone-iodine was associated with a lower rate of infectious morbidity (3.0% vs 4.3%; P=.01), urinary tract infection (1.1% vs 1.7%; P=.03) and emergency department visits (7.9% vs 9.7%; P=.01) than with chlorhexidine. There were nonsignificant trends of lower rates of surgical site infection (2.0% vs 2.7%; P=.07) and reoperation (1.6% vs 2.1%; P=.18). This propensity score matched analysis provides evidence that povidone-iodine is preferable to chlorhexidine for vaginal preparation before hysterectomy because of lower rates of infectious morbidity and fewer emergency department visits. However, the absolute differences in infectious morbidity rates were approximately 1%, and in the event of an iodine allergy, chlorhexidine appears to be a reasonable alternative.

Effect of thymosin a1 on complications after laparoscopic pancreaticoduodenectomy in elderly patients

Objective To investigate the association between perioperative immune status and postoperative infectious complications in elderly patients undergoing laparoscopic pancreaticoduodenectomy (LPD), as well as the effect of thymosin a1 on postoperative complications. Methods Related clinical data were collected from 43 elderly patients, aged 66-83 years, who underwent LPD in The Second Affiliated Hospital of Army Medical University, PLA from June 2014 to June 2018, and the patients were divided into combination group with 22 patients (with the application of thymosin a1 in the perioperative period) and control group with 21 patients (without the application of thymosin a1). Immune function parameters were observed before surgery and on days 3 and 7 after surgery, including serum levels of IgG, IgA, and IgM, peripheral blood neutrophil-lymphocyte ratio (NLR), changes in CD3+, CD4+, CD8+, and CD4+/CD8+ ratio, and the incidence rate of postoperative infectious complications (pulmonary infection, pancreatic leakage, and abdominal infection). In addition, the serum levels of C-reactive protein, interleukin-2 (IL-2), interleukin-10 (IL-10), tumor necrosis factor-α, and interferon-γ (IFN-γ) were measured before surgery and on days 3 and 7 after surgery. The t-test was used for comparison of continuous data between two groups; a repeated measures analysis of variance was used for comparison within each group at different time points, and the Duncan's new multiple range test was used for further pairwise comparison. The chi-square test was used for comparison of categorical data between groups. Results Compared with the control group on days 3 and 7 after surgery, the combination group had significantly higher serum levels of IgG, IgA, IgM, CD3+, CD4+, CD8+, and CD4+/CD8+ ratio (all P Conclusion Surgical trauma can further reduce the immune function of elderly patients, and the use of thymosin a1 during the perioperative period can enhance the immune function of patients and reduce the incidence rate of postoperative infectious complications.

Clinical Significance of Postoperative Antibiotic Treatment for Positive Islet Cultures After Total Pancreatectomy With Islet Autotransplantation.

Islet cultures are routinely performed in total pancreatectomy with islet autotransplantation (TPIAT), and the need for empiric antibiotic treatment based on culture results is unknown. We evaluated the effect of postoperative antibiotic treatment for positive islet cultures on clinical infection. Seventy-nine patients undergoing TPIAT were reviewed. Prophylactic perioperative ceftriaxone and metronidazole were administered, and transplanted islet preparations included ciprofloxacin. Postoperative antibiotics were not routinely given for positive cultures unless a clinical infection was suspected. The primary end point was 30-day infectious complications. Fifty-one patients (65%) had a positive culture. Overall, 39 patients (87%) had organisms susceptible to our perioperative antibiotic regimen. There was no difference in the infectious complication rate between those with positive compared with negative cultures (16% vs 29%, P = 0.17). Patients with a positive culture had similar 30-day postoperative infectious complication rates whether receiving postoperative antibiotics (n = 7) or not (14% vs 16%, P = 0.91). Only 1 patient had a correlation of clinical and islet cultures. Beyond prophylactic antibiotics, empiric antibiotic treatment for a positive culture is not warranted and provides a rationale for the abandonment of routine cultures in TPIAT.

Splenic preservation versus splenectomy during laparoscopic distal pancreatectomy for benign and low-grade malignant pancreatic tumor: A propensity score matching analysis

Previous studies showed the advantages of spleen preservation during laparoscopic distal pancreatectomy (LDP) such as preventing overwhelming postsplenectomy infection, and early infectious complications, maintaining immune surveillance, less postoperative pancreatic fistula, less postpancreatectomy diabetes, and less gastric ileus. However, there were limitations of these results such as heterogenous population, and small number of patients. This study was aimed to compare clinical outcomes of patients with LDP with splenectomy (LDPS) and laparoscopic spleen preserving distal pancreatectomy (LSDP) using propensity score matching analysis from data of multi centers in Korea and Japan. The patients were identified who underwent LDPS and LSDP in Korea and Japan. Perioperative outcomes including postoperative infectious complication were compared between LDPS and LSDP before and after PSM. Matching variables were used such as nation, age, sex, BMI, ASA scores, underlying disease, previous abdominal surgery, preoperative pancreatitis, malignant disease and tumor locations. LDPS and LSDP were classified in 1,728 (39.6%), and 2,635 (60.4%), respectively. In the mean age and body mass index were 56.3 and 23.4. And 1,166 (26.7%) patients underwent previous abdominal surgery and tumor was located in body and tail in 2,041 (46.8%) and 2,290 (52.5%), respectively. Pancreas was transected at pancreas neck and tail level in 1,794 (41.1%) and 2,521 (57.8%), respectively. Splenic vessels were preserved in 1,244 (28.5%) of 2,635 patients with LSDP. Two hundred patients (4.6%) experienced conversion to open during surgery. Of patients, 1,303 (29.9%) patients experienced postoperative complications. Clinically related postoperative pancreatic fistula (CR-POPF) and infectious complication rates were 693 (15.3%) and 760 (17.4%) patients, respectively. After PSM, 1,594 patients were selected in each group. The patients with LSDP showed comparable overall complication (35.7 % vs. 38.4 %, p = 0.094), however LSDP group showed lower infectious complications (15.2 % vs. 19.1 %, p = 0.036), CR-POPF (13.7 % vs. 18.7 %, p < 0.001), infected POPF (5.7 % vs. 9.7 %, p < 0.001), complicated fluid collection (0.94% vs. 2.82%, p < 0.001) compared with the patients with LDP. The results of this study showed that LSDP was related with lower infectious complication rate including lower infected POPF, and lower complicated fluid collection compared with LDPS, and this result is helpful to decide splenic preservation in patients who needs LDP for pancreatic body or tail lesions.

The Effect of Perioperative Administration of Probiotics on Colorectal Cancer Surgery Outcomes.

The perioperative care of colorectal cancer (CRC) patients includes antibiotics. Although antibiotics do provide a certain protection against infections, they do not eliminate them completely, and they do carry risks of microbial resistance and disruption of the microbiome. Probiotics can maintain the microbiome’s balance postoperatively by maintaining intestinal mucosal integrity and reducing bacterial translocation (BT). This review aims to assess the role of probiotics in the perioperative management of CRC patients. The outcomes were categorised into: postoperative infectious and non-infectious complications, BT rate analysis, and intestinal permeability assessment. Fifteen randomised controlled trials (RCTs) were included. There was a trend towards lower rates of postoperative infectious and non-infectious complications with probiotics versus placebo. Probiotics reduced BT, maintained intestinal mucosal permeability, and provided a better balance of beneficial to pathogenic microorganisms. Heterogeneity among RCTs was high. Factors that influence the effect of probiotics include the species used, using a combination vs. single species, the duration of administration, and the location of the bowel resection. Although this review provided evidence for how probiotics possibly operate and reported notable evidence that probiotics can lower rates of infections, heterogeneity was observed. In order to corroborate the findings, future RCTs should keep the aforementioned factors constant.