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Society for Surgery of the Alimentary Tract

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Abdulrahman Y. Hammad*1,2, Hussein H. Khachfe1,2, Samer AlMasri2, Annissa deSilva2, Hao Liu2, Ibrahim Nassour2,3, Kenneth Lee2, Amer H. Zureikat2, Alessandro Paniccia2
1Surgery, University of Pittsburgh, Pittsburgh, PA; 2UPMC, Pittsburgh, PA; 3University of Florida, Gainesville, FL

INTRODUCTION: Pancreaticoduodenectomy (PD) remains a complex surgical procedure with infectious complications affecting approximately 35% of patients. Patients who undergo biliary drainage with metal stent placement prior to neoadjuvant treatment (NAT) are thought to have a higher infection rate following PD, and longer duration of peri-operative antibiotic are proposed to be protective. The aim of the current study is to evaluate the differences in postoperative infectious complications in patients undergoing PD between two groups receiving short- and long-term peri-operative courses of antibiotics.
METHODS: A retrospective institutional pancreatic cancer database was queried for patients who had a metal biliary stent placed prior to NAT initiation, followed by subsequent PD between 2014-2021. Duration of postoperative prophylactic antibiotics was defined as short (SC: ?24 hrs.) or extended (EC: 3-7 days). Outcomes of interest included superficial surgical site infection (SSI) and deep organ SSI.
RESULTS: Two hundred and eighty-one (n=281) patients were identified of which the majority (n=205, 72.9%) received a short course of antibiotics postoperatively. Baseline characteristics were similar between the two cohorts including age, sex, BMI, and comorbidity index. EC patients received more NAT cycles (4 vs. 3, p<0.001 and underwent an open PD more frequently (61.8% vs. 41.0%, p=0.002). Superficial SSI occurred in 38 (18.5%) SC patients vs. 6 (7.9%) EC, (p=0.029) while 20 patients (9.8%) developed deep organ SSI compared to 3 (3.9%), (p= 0.231; SC vs. EC, respectively). Additionally, the SC cohort demonstrated higher incidence of major complications (Clavien-Dindo?3: 51 [24.9%] vs. 9 [11.8%], p=0.018) and had a longer length of stay (7 days vs. 6 days, p=0.017). No difference in Colistridum Difficile infection rate was seen between both cohorts 9 (4.4%) vs. 4 (5.3%), (p=0.757; SC vs EC, respectively). On logistic regression model examining factors associated with superficial SSI, higher BMI (continuous variable) was associated with increased odds of superficial SSI (OR: 1.07 [95%CI: 1.01, 1.13], p=0.010), while EC was protective (OR: 0.39 [95%CI: 0.15, 0.97], p=0.045).
CONCLUSIONS: This data suggest that an extended course of perioperative antibiotic might correlate with reduction in superficial SSI following PD in patients with metal biliary stent placed prior to NAT course. These results require validation in a randomized clinical trial examining a larger cohort of patients and comparing the types of peri-operative antibiotics administered.

Table 1. Descriptive Data and Outcomes of Patients who Underwent Pancreaticoduodenectomy with Preoperative Metallic Biliary Stenting Categorized by Short and Extended Postoperative Prophylactic Antibiotic Course

Table 2. Univariate and Multivariate logistic regression model examining factors associated with Superficial Surgical Site infection

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