Abstract
Purpose
Malnutrition has been considered a risk factor for the development of a surgical site infection (SSI). The aim of this study was to determine the relationship between preoperative nutritional screening scores and the development of SSI after pancreaticoduodenectomy.
Methods
We examined 64 patients who had undergone pancreaticoduodenectomy. Their clinical data, nutritional risk index (NRI), and nutritional risk screening 2002 (NRS-2002) score were recorded. SSIs were diagnosed according to the definitions of wound infection established by the Center for Disease Control and Prevention and were confirmed by a microbiological examination. Data were analyzed using the Fisher exact probability method and a multivariate logistic regression analysis.
Results
SSIs developed in 21 patients (33 %). Eleven patients had wound infections, and 14 patients had an intra-abdominal abscess. A univariate analysis of perioperative factors revealed that a pancreatic fistula, the NRS-2002, and the NRI were significantly associated with the development of SSI (p < 0.05). The multivariate logistic regression analysis revealed that a pancreatic fistula and the NRI were independent risk factors for SSI. By analyzing the pre- and intra-operative factors after excluding the 11 patients with pancreatic fistulas, the NRI was still an independent risk factor for SSI.
Conclusion
The present study showed the NRI to be an independent factor for predicting the risk of SSI after pancreaticoduodenectomy.
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Abbreviations
- SSI:
-
Surgical site infection
- NRS-2002:
-
Nutritional risk screening 2002
- NRI:
-
Nutritional risk index
- BMI:
-
Body mass index
- MRSA:
-
Methicillin-resistant Staphylococcus aureus
References
Glasgow RE, Jackson HH, Neumayer L, Schifftner TL, Khuri SF, Henderson WG, et al. Pancreatic resection in Veterans Affairs and selected university medical centers: results of the patient safety in surgery study. J Am Coll Surg. 2007;204(6):1252–60.
Kingsnorth AN. Surgery for periampullary and pancreatic carcinoma: a Liverpool experience. Ann R Coll Surg Engl. 1997;79(4):259–63.
Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997;226(3):248–57. discussion 257–260.
Kawai M, Yamaue H. Analysis of clinical trials evaluating complications after pancreaticoduodenectomy: a new era of pancreatic surgery. Surg Today. 2010;40:1011–7.
Lin SC, Shan YS, Lin PW. Adequate preoperative biliary drainage is determinative to decrease postoperative infectious complications after pancreaticoduodenectomy. Hepatogastroenterology. 2010;57(101):698–705.
Kimura F, Shimizu H, Yoshidome H, Ohtsuka M, Kato A, Yoshitomi H, et al. Increased plasma levels of IL-6 and IL-8 are associated with surgical site infection after pancreaticoduodenectomy. Pancreas. 2006;32(2):178–85.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20(4):250–78. quiz 279–280.
Olson MM, Lee JT Jr. Continuous, 10-year wound infection surveillance. Results, advantages, and unanswered questions. Arch Surg. 1990;125(6):794–803.
Su Z, Koga R, Saiura A, Natori T, Yamaguchi T, Yamamoto J. Factors influencing infectious complications after pancreatoduodenectomy. J Hepatobiliary Pancreat Sci. 2010;17(2):174–9.
Limongelli P, Pai M, Bansi D, Thiallinagram A, Tait P, Jackson J, et al. Correlation between preoperative biliary drainage, bile duct contamination, and postoperative outcomes for pancreatic surgery. Surgery. 2007;142(3):313–8.
Inoue Y, Miki C, Kusunoki M. Nutritional status and cytokine-related protein breakdown in elderly patients with gastrointestinal malignancies. J Surg Oncol. 2004;86(2):91–8.
Sungurtekin H, Sungurtekin U, Balci C, Zencir M, Erdem E. The influence of nutritional status on complications after major intraabdominal surgery. J Am Coll Nutr. 2004;23(3):227–32.
Kuzu MA, Terzioglu H, Genc V, Erkek AB, Ozban M, Sonyurek P, et al. Preoperative nutritional risk assessment in predicting postoperative outcome in patients undergoing major surgery. World J Surg. 2006;30(3):378–90.
Schiesser M, Kirchhoff P, Muller MK, Schafer M, Clavien PA. The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery. Surgery. 2009;145(5):519–26.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27(2):97–132. quiz 133–134; discussion 196.
Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P, et al. ESPEN Guidelines on Enteral Nutrition: surgery including organ transplantation. Clin Nutr. 2006;25(2):224–44.
Ryu SW, Kim IH. Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients. World J Gastroenterol. 2010;16(26):3310–7.
Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415–21.
Perioperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. N Engl J Med 1991;325(8): 525–32.
Antoun S, Rey A, Beal J, Montange F, Pressoir M, Vasson MP, et al. Nutritional risk factors in planned oncologic surgery: what clinical and biological parameters should be routinely used? World J Surg. 2009;33(8):1633–40.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8–13.
Aranha GV, Aaron JM, Shoup M, Pickleman J. Current management of pancreatic fistula after pancreaticoduodenectomy. Surgery. 2006;140(4):561–8. discussion 568–569.
Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606–8.
Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control. 2007;35(10 Suppl 2):S65–164.
National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32(8): 470–85.
Anielski R, Barczynski M. Postoperative wound infections. III. Patient related risk factors. Przegl Lek. 1998;55(11):565–71.
Malone DL, Genuit T, Tracy JK, Gannon C, Napolitano LM. Surgical site infections: reanalysis of risk factors. J Surg Res. 2002;103(1):89–95.
Ulicny KS Jr, Hiratzka LF, Williams RB, Grunkemeier GL, Flege JB Jr, Wright CB, et al. Sternotomy infection: poor prediction by acute phase response and delayed hypersensitivity. Ann Thorac Surg. 1990;50(6):949–58.
Pacelli F, Bossola M, Rosa F, Tortorelli AP, Papa V, Doglietto GB. Is malnutrition still a risk factor of postoperative complications in gastric cancer surgery? Clin Nutr. 2008;27(3):398–407.
Hennessey DB, Burke JP, Ni-Dhonochu T, Shields C, Winter DC, Mealy K. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann Surg. 2010;252(2):325–9.
Delgado-Rodriguez M, Medina-Cuadros M, Gomez-Ortega A, Martinez-Gallego G, Mariscal-Ortiz M, Martinez-Gonzalez MA, et al. Cholesterol and serum albumin levels as predictors of cross infection, death, and length of hospital stay. Arch Surg. 2002;137(7):805–12.
Schneider SM, Hebuterne X. Use of nutritional scores to predict clinical outcomes in chronic diseases. Nutr Rev. 2000;58(2 Pt 1):31–8.
Kyle UG, Pirlich M, Schuetz T, Luebke HJ, Lochs H, Pichard C. Prevalence of malnutrition in 1760 patients at hospital admission: a controlled population study of body composition. Clin Nutr. 2003;22(5):473–81.
Corish CA. Pre-operative nutritional assessment. Proc Nutr Soc. 1999;58(4):821–9.
Cohendy R, Gros T, Arnaud-Battandier F, Tran G, Plaze JM, Eledjam J. Preoperative nutritional evaluation of elderly patients: the Mini Nutritional Assessment as a practical tool. Clin Nutr. 1999;18(6):345–8.
Padillo FJ, Rodriguez M, Gallardo JM, Andicoberry B, Naranjo A, Mino G, et al. Changes in the pattern of visceral protein concentrations after internal biliary drainage in patients with obstructive jaundice. Eur J Surg. 1999;165(6):550–5.
Padillo FJ, Andicoberry B, Muntane J, Lozano JM, Mino G, et al. Factors predicting nutritional derangements in patients with obstructive jaundice: multivariate analysis. World J Surg. 2001;25(4):413–8.
Goonetilleke KS, Siriwardena AK. Systematic review of peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy. JOP. 2006;7(1):5–13.
Choe YM, Lee KY, Oh CA, Lee JB, Choi SK, Hur YS, et al. Risk factors affecting pancreatic fistulas after pancreaticoduodenectomy. World J Gastroenterol. 2008;14(45):6970–4.
Tajima Y, Kuroki T, Tsuneoka N, Adachi T, Kosaka T, Okamoto T, et al. Anatomy-specific pancreatic stump management to reduce the risk of pancreatic fistula after pancreatic head resection. World J Surg. 2009;33(10):2166–76.
Daly JM, Weintraub FN, Shou J, Rosato EF, Lucia M. Enteral nutrition during multimodality therapy in upper gastrointestinal cancer patients. Ann Surg. 1995;221(4):327–38.
Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, Morgenstein-Wagner TB, et al. Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg. 1992;216(2):172–83.
Moskovitz DN, Kim YI. Does perioperative immunonutrition reduce postoperative complications in patients with gastrointestinal cancer undergoing operations? Nutr Rev. 2004;62(11):443–7.
National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1990-May 1999, issued June 1999. Am J Infect Control. 1999;27(6): 520–32.
Kaya E, Yetim I, Dervisoglu A, Sunbul M, Bek Y. Risk factors for and effect of a one-year surveillance program on surgical site infection at a university hospital in Turkey. Surg Infect (Larchmt). 2006;7(6):519–26.
Ueno T, Yamamoto K, Kawaoka T, Takashima M, Oka M. Current antibiotic prophylaxis in pancreatoduodenectomy in Japan. J Hepatobiliary Pancreat Surg. 2005;12(4):304–9.
Targarona EM, Garau J, Munoz-Ramos C, Roset F, Lite J, Matas E, et al. Single-dose antibiotic prophylaxis in patients at high risk for infection in biliary surgery: a prospective and randomized study comparing cefonicid with mezlocillin. Surgery. 1990;107(3):327–34.
Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH. Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg. 1993;128(1):79–88.
Sudo T, Murakami Y, Uemura K, Hayashidani Y, Hashimoto Y, Ohge H, et al. Specific antibiotic prophylaxis based on bile cultures is required to prevent postoperative infectious complications in pancreatoduodenectomy patients who have undergone preoperative biliary drainage. World J Surg. 2007;31(11):2230–5.
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Hiroji Shinkawa and co-authors have no conflict of interest.
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Shinkawa, H., Takemura, S., Uenishi, T. et al. Nutritional risk index as an independent predictive factor for the development of surgical site infection after pancreaticoduodenectomy. Surg Today 43, 276–283 (2013). https://doi.org/10.1007/s00595-012-0350-2
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DOI: https://doi.org/10.1007/s00595-012-0350-2