Journal of Gastrointestinal Surgery

, Volume 17, Issue 11, pp 1907–1916

Identification and Validation of Risk Factors for Postoperative Infectious Complications Following Hepatectomy

  • Patrick Pessaux
  • Maartje A. J. van den Broek
  • Tao Wu
  • Steven W. M. Olde Damink
  • Tullio Piardi
  • Cornelis H. C. Dejong
  • Dimitrios Ntourakis
  • Ronald M. van Dam
Original Article

DOI: 10.1007/s11605-013-2226-1

Cite this article as:
Pessaux, P., van den Broek, M.A.J., Wu, T. et al. J Gastrointest Surg (2013) 17: 1907. doi:10.1007/s11605-013-2226-1

Abstract

Summary

Postoperative infectious complications (PICs) are associated with significant morbidity after abdominal surgery. Using multivariate analysis of data from a prospective database, our study focused on the risk factors for PICs and the prevention of these complications after hepatectomy, with the goal of improving outcomes and reducing the length of hospital stays.

Background

PICs following surgery are associated with significant morbidity, increase the length of hospital stays, and have a negative impact on long-term oncological outcome. The aim of this study was to determine the risk factors for PICs following partial hepatectomy and to validate these results with an external database.

Methods

Between January 2006 and December 2009, 555 patients underwent elective partial hepatectomy. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. The dependent variables studied were the occurrence of PICs, defined as development of one or more of the following conditions: pneumonia, sepsis, Central line-associated bloodstream infection, urinary tract infection, wound infection, and infected intra-abdominal fluid collection. PICs were devised in medical (PIMCs) and surgical (PISCs) complications. The incidence of PICs and validation of the predictive score were determined using an external prospective database of 342 patients.

Results

The multivariate analysis identified three independent risk factors for PICs: the presence of a nasogastric tube (OR = 1.8), blood transfusion (OR = 1.9), and diabetes (OR = 2.4). The multivariate analysis identified only one independent risk factor for PISCs: an associated portal venous resection (OR = 5.5). The multivariate analysis identified four independent risk factors for PIMCs: presence of a biliary drainage (OR = 1.9), blood transfusion (OR = 2.1), diabetes (OR = 2.9), and presence of atrial fibrillation (OR = 3.6). According to the three predictive factors, the observed rates of PICs ranged from 18.8 % to 77.8 % and ranged from 24.2 % to 100 % in the external database. Predicted and observed risks of PICs were not statistically different.

Conclusions

The correction of modifiable risk factors among the identified factors could reduce the incidence of PICs and, as a consequence, improve patient outcomes and reduce the length of hospital stays.

Keywords

Hepatectomy Postoperative infectious complications Prevention Predictive score Risk factor 

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Patrick Pessaux
    • 1
  • Maartje A. J. van den Broek
    • 2
  • Tao Wu
    • 3
  • Steven W. M. Olde Damink
    • 2
    • 4
  • Tullio Piardi
    • 1
  • Cornelis H. C. Dejong
    • 2
  • Dimitrios Ntourakis
    • 1
  • Ronald M. van Dam
    • 2
  1. 1.Department of Hepato-Biliary and Pancreatic Surgery, Nouvel Hopital CivilUniversité de StrasbourgStrasbourgFrance
  2. 2.Department of Surgery and NUTRIM, School for Nutrition, Toxicology and MetabolismMaastricht University Medical CentreMaastrichtThe Netherlands
  3. 3.Department of Hepato-Biliary and Pancreatic Surgery, University Hospital N°2University of KunmingKunmingChina
  4. 4.Department of Hepatopancreatobiliary Surgery and Liver TransplantationRoyal Free HospitalLondonUK