The aim of this meta-analysis and systematic review was to evaluate the association
between intraoperative bile cultures and postoperative complications of patients undergoing
A detailed literature search was performed from January 2015 to July 2022 in PubMed,
Web of Science, Google Scholar, and EMBASE for related research publications. The
data were extracted, screened, and graded independently. An analysis of pooled data
was performed, and a risk ratio with corresponding confidence intervals was calculated
A total of 8 articles were included with 1,778 pancreaticoduodenectomy patients who
had an intraoperative bile culture performed. A systematic review demonstrated that
some of the most common organisms isolated in a positive intraoperative bile culture
were Enterococcus species, Klebsiella species, and E. coli. Four studies also showed that specific microorganisms were associated with specific
postoperative complications (surgical site infection and intra-abdominal abscess).
The postoperative complications that were evaluated for an association with a positive
intraoperative bile culture were surgical site infections (risk ratio = 2.33, 95%
confidence interval [1.47–3.69], P < .01), delayed gastric emptying (risk ratio = 1.23, 95% confidence interval [0.63–2.38],
P = n.s.), 90-day mortality (risk ratio = 0.68, 95% confidence interval [0.01–52.76],
P = n.s.), postoperative pancreatic hemorrhage (risk ratio = 1.70, 95% confidence interval
[0.33–8.74], P = n.s.), intra-abdominal abscess (risk ratio = 1.70, 95% confidence interval [0.38–7.56],
P = n.s.), and postoperative pancreatic fistula (risk ratio = 0.97, 95% confidence
interval [0.72–1.32], P = n.s.).
The cumulative data suggest that a positive intraoperative bile culture has no association
with predicting the postoperative complications of delayed gastric emptying, 90-day
mortality, postoperative pancreatic hemorrhage, intra-abdominal abscess, or postoperative
pancreatic fistula. However, the data also suggest that a positive intraoperative
bile culture was associated with a patient developing a surgical site infection.