Pancreatoduodenectomy within 2 weeks after endoscopic retrograde cholangio-pancreatography increases the risk of organ/space surgical site infections: a 5-year retrospective cohort study in a high-volume centre

Wensen Chen; Kai Zhang; Zhongheng Zhang; Zipeng Lu; Daoquan Zhang; Juan Liu; Yue Yang; Yinzhi Leng; Yongxiang Zhang; Weihong Zhang; Kuirong Jiang; Guihua Zhuang; Yi Miao; Yun Liu

doi:10.21037/gs-20-826

Pancreatoduodenectomy within 2 weeks after endoscopic retrograde cholangio-pancreatography increases the risk of organ/space surgical site infections: a 5-year retrospective cohort study in a high-volume centre

Gland Surg. 2021 Jun;10(6):1852-1864. doi: 10.21037/gs-20-826.

Authors

Wensen Chen^{1

2}, Kai Zhang^{3

4}, Zhongheng Zhang⁵, Zipeng Lu^{3

4}, Daoquan Zhang⁶, Juan Liu², Yue Yang², Yinzhi Leng⁷, Yongxiang Zhang², Weihong Zhang⁸, Kuirong Jiang^{3

4}, Guihua Zhuang¹, Yi Miao^{3

4}, Yun Liu^{9

10

11}

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
² Office of Infection Management, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
³ Pancreas Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
⁴ Pancreas Institute of Nanjing Medical University, Nanjing, China.
⁵ Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
⁶ Department of Endoscopy, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
⁷ Department of Infection, Nanjing Traditional Chinese Medicine Hospital, Nanjing, China.
⁸ Office of Infection Management, Jiangsu Province Hospital & Jiangsu Shengze Hospital, Suzhou, China.
⁹ Department of Geriatrics Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
¹⁰ Department of Medical Informatics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China.
¹¹ Institute of Medical Informatics and Management, Nanjing Medical University, Nanjing, China.

Abstract

Background: Organ/space surgical site infections (OSSI) after pancreaticoduodenectomy (PD) are not rare events. The role of diagnosis and treatment for pancreatic and biliary diseases with an endoscopic retrograde cholangio-pancreatography (ERCP) procedure is currently controversial. However, the ERCP procedure might play a role in surgical outcomes after PD.

Methods: We conducted a retrospective cohort study for patients who underwent PD in the First Affiliated Hospital with the Nanjing Medical University from 1st September 2012 to 31st January 2018. The relationship between ERCP exposure and OSSI after PD was analyzed by univariate and forward stepwise multivariate logistic regression model.

Results: Of the 1,365 patients who underwent PD, 136 developed OSSI (10.0%). We found that ERCP exposure before PD (EEBPD) was significantly associated with an increased incidence rate of post-operative pancreas fistula (POPF) [24.2% (23/95) vs. 14.9% (189/1,270), risk ratio (RR) =1.63, 95% confidence interval (CI), 1.11-2.38, P=0.015]. Hypertension, a higher level of preoperative low-density lipoprotein (LDL) and creatinine (Cr) were associated with elevated risks of post-operative OSSI [adjusted odds ratio (Adj-OR) (95% CI) were 1.59 (1.09-2.32), 1.70 (1.16-2.51), 1.99 (1.36-2.92)], whereas a preoperatively higher level of aspartate aminotransferase (AST) would decrease the risk [Adj-OR (95% CI), 0.62 (0.42-0.91)]. Remarkably, EEBPD would significantly increase and more than double the OSSI risk [Adj-OR (95% CI), 2.56 (1.46-4.47)] especially if it was within 14 days before surgery (Spearman =-0.698, P<0.001).

Conclusions: ERCP, as an independent risk factor, significantly increased the risk of post-operative OSSI after PD if it is performed within 14 days prior to surgery. Our findings would assist clinical decision-making, and improve OSSI control and prevention.

Keywords: Endoscopic retrograde cholangio-pancreatography (ERCP); logistic regression; organ/space surgical site infections (OSSI); pancreaticoduodenectomy (PD).