Abstract
Background
The aim of this study was to analyze the risk factors for surgical infectious complications
and the outcomes of patients undergoing surgery for perihilar cholangiocarcinoma according
to the microbiological examinations.
Methods
Patients who underwent surgery for perihilar cholangiocarcinoma in the last decade
were enrolled, and all clinical and microbiological data were collected from a retrospective
monocentric database. Univariate and multivariate analyses were performed distinguishing
patients who developed at least 1 surgical infectious complication (surgical site
infections, acute bacterial cholangitis, bacteremia).
Results
A total of 98 patients were included. Among patients who developed surgical infectious
complications (51%), many preoperative characteristics were significantly more frequent:
American Society of Anesthesiologists score ≥3 (P = .026), neutrophil-to-lymphocyte ratio ≥3.4 (P = .001), endoscopic sphincterotomy (P = .032), ≥2 biliary drainage procedures (P = .013), acute cholangitis (P = .012), multidrug resistant (P = .009), and ≥3 microorganisms’ detection (P = .042); whereas during the postoperative period, surgical infectious complications
were associated to increased incidence of intensive care unit readmission (P = .031), major complications (P < .001), posthepatectomy liver failure (P = .005), ascites (P = .008), biliary leakage (P = .008), 90-day readmission (P = .003), and prolonged length of hospital stay (P < .001). At the multivariate analysis 3 independent preoperative risk factors for
surgical infectious complications were identified: neutrophil-to-lymphocyte ratio
≥3.4 (P = .004), endoscopic sphincterotomy (P = .009), and acute cholangitis (P = .013). The presence of multidrug-resistance in the perioperative biliary cultures
was related to postoperative multidrug-resistant species from all cultures (P < .001) and organ/space and incisional–surgical site infections (P ≤ .044).
Conclusion
Infective complications after surgery for perihilar cholangiocarcinoma worsen the
short-term outcomes. A careful microbiological surveillance should be carried out
in all cases to prevent and promptly treat surgical infectious complications.
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: May 24, 2022
Accepted:
April 18,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
