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19-03-2024 | Antibiotic | Original Article

Perioperative pancreaticoduodenectomy management strategy focusing on postoperative early drain colonization

Authors: Akira Watanabe, Norifumi Harimoto, Kenichiro Araki, Takamichi Igarashi, Mariko Tsukagoshi, Norihiro Ishii, Kei Hagiwara, Katsuhiko Tsunekawa, Masami Murakami, Ken Shirabe

Published in: Surgery Today

Abstract

Purpose

Pancreatoduodenectomy (PD) is a highly invasive procedure. Intra-abdominal infections and pancreatic fistulas are strongly correlated complications. In the present study, we identified the risk factors for postoperative early drain colonization (POEDC) and established a perioperative management strategy.

Methods

A total of 205 patients who underwent pancreatoduodenectomy were included in the study. POEDC was defined as a positive drain fluid culture before postoperative day (POD) 4. We retrospectively investigated the correlation between POEDC, postoperative outcomes, and clinical factors.

Results

POEDC was observed in 26 patients (12.6%) with poor postoperative outcomes, including pancreatic fistulas (P < 0.001). A multivariate analysis demonstrated a correlation between these postoperative outcomes and the age (P = 0.002), body mass index (BMI) (P = 0.002), procalcitonin (PCT) level (P < 0.001), and drain amylase level on POD 1 (P = 0.032). Enterococcus was detected most frequently, being found in 15 patients.

Conclusion

We observed a strong correlation between POEDC and poor postoperative outcomes. The BMI, age, and PCT and drain amylase level on POD 1 should be considered POEDC risk factors, with the need to propose an antibiotic perioperative strategy. POEDC control may represent the key to improving postoperative outcomes after PD.

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Title: Perioperative pancreaticoduodenectomy management strategy focusing on postoperative early drain colonization
Authors: Akira Watanabe
Norifumi Harimoto
Kenichiro Araki
Takamichi Igarashi
Mariko Tsukagoshi
Norihiro Ishii
Kei Hagiwara
Katsuhiko Tsunekawa
Masami Murakami
Ken Shirabe
Publication date: 19-03-2024
Publisher: Springer Nature Singapore
Keywords: Antibiotic
Pancreatoduodenostomy
Pancreatoduodenostomy
Published in: Surgery Today
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-024-02810-4

At a glance: The STEP trials

Springer Medicine

Perioperative pancreaticoduodenectomy management strategy focusing on postoperative early drain colonization

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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