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Risk factors for postoperative infectious complications after hepatectomy

  • Original article
  • Published:
Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background/purpose

This study aimed to clarify the incidence of surgical site infections (SSIs) after hepatectomy.

Methods

The database records of three hundred and eight patients who underwent elective surgical treatment for hepatolithiasis, hepatocellular carcinoma (HCC), and metastatic carcinoma were retrospectively analyzed to determine the occurrence of postoperative infectious complications. The incidences of SSIs, classified as superficial or deep incisional SSIs and organ or space SSIs, and all other infectious complications within 30 days after hepatectomy were evaluated.

Results

The incidences of SSIs after a hepatectomy for hepatolithiasis (23.8%) were higher than those after a hepatectomy for HCC (11.3%) (p = 0.034) and after a hepatectomy for metastatic carcinoma (2.7%) (p < 0.001), and the incidence of SSIs after a hepatectomy for HCC was higher than that after a hepatectomy for metastatic carcinoma (p = 0.028). However, there was no significant difference in the incidence of remote site infections between the three groups. The incidence of superficial or deep incisional SSIs after a hepatectomy for hepatolithiasis (11.9%) was higher than that after a hepatectomy for metastatic carcinoma (1.4%) (p < 0.001) and the incidence of superficial or deep incisional SSIs after a hepatectomy for HCC (7.8%) was higher than that after a hepatectomy for metastatic carcinoma (1.4%) (p = 0.050). There was a significant difference in the incidence of space/organ SSIs between the patients with hepatolithiasis (11.9%) and HCC patients (3.6%) (p = 0.029), and between the patients with hepatolithiasis and metastatic carcinoma patients (1.4%) (p < 0.001). The rate of positive bile culture was 36.2% in all patients in this study, and the rates were 83.3, 7.8, and 10.0% for patients with hepatolithiasis, HCC, and metastatic carcinoma, respectively. A significantly higher (p < 0.001) positive bile culture rate was observed in patients with hepatolithiasis as compared with HCC or metastatic carcinoma patients.

Conclusions

Our study suggests the existence of a relationship between postoperative SSIs and bile infection, thus supporting the proposed relationship between post-hepatectomy infection and such variables as liver function, blood sugar control, and nutritional status.

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References

  1. Erdogan D, Busch OR, van Delden OM, Rauws EA, Gouma DJ, van Gulik TM. Incidence and management of bile leakage after partial liver resection. Dig Surg. 2008;25:60–6.

    Article  CAS  PubMed  Google Scholar 

  2. Togo S, Matsuo K, Tanaka K, Matsumoto C, Shimizu T, Ueda M, et al. Perioperative infection control and its effectiveness in hepatectomy patients. J Gastroenterol Hepatol. 2007;22:1942–8.

    Article  PubMed  Google Scholar 

  3. Li SQ, Liang LJ, Peng BG, Lu MD, Lai JM, Li DM. Bile leakage after hepatectomy for hepatolithiasis: risk factors and management. Surgery. 2007;141:340–5.

    Article  PubMed  Google Scholar 

  4. 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;27:97–132.

    Article  CAS  PubMed  Google Scholar 

  5. Uchiyama K, Kawai M, Ueno M, Ozawa S, Tani M, Yamaue H. Reducing residual and recurrent stones by hepatectomy for hepatolithiasis. J Gastrointest Surg. 2007;11:626–30.

    Article  PubMed  Google Scholar 

  6. Uchiyama K, Onishi H, Tani M, Kinoshita H, Kawai M, Ueno M, et al. Long-term prognosis after treatment of patients with choledocholithiasis. Ann Surg. 2003;238:97–102.

    Article  PubMed  Google Scholar 

  7. Uchiyama K, Kawai M, Onishi H, Tani M, Kinoshita H, Ueno M, et al. Preoperative antimicrobial administration for prevention of postoperative infection in patients with laparoscopic cholecystectomy. Dig Dis Sci. 2003;48:1955–9.

    Article  PubMed  Google Scholar 

  8. Kobayashi S, Gotohda N, Nakagohri T, Takahashi S, Konishi M, Kinoshita T. Risk factors of surgical site infection after hepatectomy for liver cancers. World J Surg. 2009;33:312–7.

    Article  CAS  PubMed  Google Scholar 

  9. Uchiyama K, Ueno M, Ozawa S, Hayami S, Kawai M, Tani M, et al. Half clamping of the infrahepatic inferior vena cava reduces bleeding during a hepatectomy by decreasing the central venous pressure. Langenbecks Arch Surg. 2009;394:243–7.

    Article  PubMed  Google Scholar 

  10. Hasegawa K, Kokudo N, Imamura H, Matsuyama Y, Aoki T, Minagawa M, et al. Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg. 2005;242:252–9.

    Article  PubMed  Google Scholar 

  11. Gonzales R, Bartlett JG, Besser RE, Cooper RJ, Hickner JM, Hoffman JR, et al. Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: background, specific aims, and methods. Ann Intern Med. 2001;134:479–86.

    CAS  PubMed  Google Scholar 

  12. Manges AR, Johnson JR, Foxman B, O’Bryan TT, Fullerton KE, Riley LW. Wide spread distribution of urinary tract infections caused by a multidrug-resistant Escherichia coli clonal group. N Engl J Med. 2001;345:1007–13.

    Article  CAS  PubMed  Google Scholar 

  13. Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg. 2000;191:38–46.

    Article  CAS  PubMed  Google Scholar 

  14. Behrns KE, Tsiotos GG, DeSouza NF, Krishna MK, Ludwig J, Nagorney DM. Hepatic steatosis as a potential risk factor for major hepatic resection. J Gastrointest Surg. 1998;2:292–8.

    Article  CAS  PubMed  Google Scholar 

  15. Schindl MJ, Millar AM, Redhead DN, Fearon KC, Ross JA, Dejong CH, et al. The adaptive response of the reticuloendothelial system to major liver resection in humans. Ann Surg. 2006;243:507–14.

    Article  PubMed  Google Scholar 

  16. Schindl MJ, Redhead DN, Fearon KC, Garden OJ, Wigmore SJ. Edinburgh Liver Surgery and Transplantation Experimental Research Group (eLISTER). The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut. 2005;54:289–96.

    Article  CAS  PubMed  Google Scholar 

  17. Wong R, Rappaport W, Witte C, Hunter G, Jaffe P, Hall K, et al. Risk of nonshunt abdominal operation in the patient with cirrhosis. J Am Coll Surg. 1994;179:412–6.

    CAS  PubMed  Google Scholar 

  18. Mansour A, Watson W, Shayani V, Pickleman J. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery. 1997;122:730–5.

    Article  CAS  PubMed  Google Scholar 

  19. Pessaux P, Msika S, Atalla D, Hay JM, Flamant Y. French Association for Surgical Research. Risk factors for postoperative infectious complications in noncolorectal abdominal surgery: a multivariate analysis based on a prospective multicenter study of 4718 patients. Arch Surg. 2003;138:314–24.

    Article  PubMed  Google Scholar 

  20. Fujita S, Saito N, Yamada T, Takii Y, Kondo K, Ohue M, et al. Randomized, multicenter trial of antibiotic prophylaxis in elective colorectal surgery: single dose vs. 3 doses of a second-generation cephalosporin without metronidazole and oral antibiotics. Arch Surg. 2007;142:657–61.

    Article  CAS  PubMed  Google Scholar 

  21. Mohri Y, Tonouchi H, Kobayashi M, Nakai K, Kusunoki M. Mie Surgical Infection Research Group. Randomized clinical trial of single- versus multiple-dose antimicrobial prophylaxis in gastric cancer surgery. Br J Surg. 2007;94:683–8.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Kazuhisa Uchiyama, Masaki Ueno, Satoru Ozawa, Shigehisa Kiriyama, Manabu Kawai, Seiko Hirono, Masaji Tani & Hiroki Yamaue

Authors
  1. Kazuhisa Uchiyama
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  2. Masaki Ueno
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  3. Satoru Ozawa
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  4. Shigehisa Kiriyama
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  5. Manabu Kawai
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  6. Seiko Hirono
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  7. Masaji Tani
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  8. Hiroki Yamaue
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Corresponding author

Correspondence to Hiroki Yamaue.

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Uchiyama, K., Ueno, M., Ozawa, S. et al. Risk factors for postoperative infectious complications after hepatectomy. J Hepatobiliary Pancreat Sci 18, 67–73 (2011). https://doi.org/10.1007/s00534-010-0313-1

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  • DOI: https://doi.org/10.1007/s00534-010-0313-1

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