Abstract:
Importance:Surgical site infection (SSI) rates are increasingly used as a quality metric. However, risk factors for SSI in pancreatic surgery remain undefined. Objective:To stratify superficial and organ-space SSIs after pancreatectomy and investigate their modifiable risk factors. Design, Setting, and Participants:This retrospective analysis included 201 patients undergoing pancreatic surgery at a university-based tertiary referral center from July 1, 2013, through June 30, 2015, and 10 371 patients from National Surgical Quality Improvement Program-Hepatopancreaticobiliary (NSQIP-HPB) Collaborative sites from January 1, 2014, through December 31, 2015. Main Outcomes and Measures:Superficial, deep-incisional, and organ-space SSIs, as defined by NSQIP. Results:Among the 201 patients treated at the single center (108 men [53.7%] and 93 women [46.3%]; median age, 48.6 years [IQR, 41.4-57.3 years]), 58 had any SSI (28.9%); 28 (13.9%), superficial SSI; 8 (4%), deep-incisional SSI; and 24 (11.9%), organ-space SSI. Independent risk factors for superficial SSI were preoperative biliary stenting (odds ratio [OR], 4.81; 95% CI, 1.25-18.56; P = .02) and use of immunosuppressive corticosteroids (OR, 13.42; 95% CI, 1.64-109.72; P = .02), whereas soft gland texture was the only risk factor for organ-space SSI (OR, 4.45; 95% CI, 1.35-14.66; P = .01). Most patients with organ-space infections also had grades B/C fistulae (15 of 24 [62.5%] vs 4 of 143 [2.8%] in patients with no SSI; P < .001). Organ/space but not superficial SSI was associated with an increased rate of sepsis (7 of 24 [29.2%] vs 4 of 143 [2.8%]; P < .001) and prolonged length of hospital stay (12 vs 8 days; P = .04). Among patients in the NSQIP-HPB Collaborative, 2057 (19.8%) had any SSI; 719 (6.9%), superficial SSI; 207 (2%), deep-incisional SSI; and 1287 (12.4%), organ-space SSI. Preoperative biliary stenting was confirmed as an independent risk factor for superficial SSI (OR, 2.07; 95% CI, 1.58-2.71; P < .001). In this larger data set, soft gland texture was an independent risk factor for superficial SSI (OR, 1.45; 95% CI, 1.14-1.85; P = .002) but was more strongly and significantly associated with organ-space SSI (OR, 2.32; 95% CI, 1.88-2.85; P < .001). Conclusions and Relevance:Preoperative biliary stenting and coriticosteroid use increase superficial SSI, even in patients receiving perioperative piperacillin-tazobactam. Additional measures, including extended broad-spectrum perioperative antibiotic treatment, should be considered in these patients. Organ/space SSIs appear to be related to pancreatic fistulae, which are not modifiable. Reporting these different subtypes as a single, overall rate may be misleading.
journal_name
JAMA Surgjournal_title
JAMA surgeryauthors
Elliott IA,Chan C,Russell TA,Dann AM,Williams JL,Damato L,Chung H,Girgis MD,Hines OJ,Reber HA,Donahue TRdoi
10.1001/jamasurg.2017.2155subject
Has Abstractpub_date
2017-11-01 00:00:00pages
1023-1029issue
11eissn
2168-6254issn
2168-6262pii
2643444journal_volume
152pub_type
杂志文章相关文献
JAMA Surgery文献大全abstract:IMPORTANCE:A physician-centered approach to systems design is fundamental to ameliorating the causes of many errors, inefficiencies, and reliability problems. OBJECTIVE:To use human factors engineering to redesign the trauma process based on previously identified impediments to care related to coordination problems, c...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.1208
更新日期:2014-09-01 00:00:00
abstract:Importance:Postoperative pancreatic fistula is a potentially life-threatening complication after pancreatoduodenectomy. Evidence for best management is lacking. Objective:To evaluate the clinical outcome of patients undergoing catheter drainage compared with relaparotomy as primary treatment for pancreatic fistula aft...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2016.5708
更新日期:2017-06-01 00:00:00
abstract:Importance:Liposomal bupivacaine is a novel extended-duration anesthetic that has recently been used for local infiltration in total knee arthroplasty (TKA). Athough liposomal bupivacaine is widely used, it is unknown if the benefits justify the cost in the veteran population at our institution. Objective:To evaluate ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.3474
更新日期:2017-01-01 00:00:00
abstract::Over the past decade, minimally invasive surgery has been introduced as a means to allow manipulation of delicate tissues with outstanding visualization of the surgical field. The purpose of this article is to review the available literature regarding early postoperative outcomes and the technical challenges of minima...
journal_title:JAMA surgery
pub_type: 杂志文章,评审
doi:10.1001/jamasurg.2013.366
更新日期:2013-12-01 00:00:00
abstract:IMPORTANCE:Population-based studies on the prevalence of symptoms after Roux-en-Y gastric bypass (RYGB) surgery are sparse. Knowledge about possible predictors of these symptoms is important for prevention. OBJECTIVES:To examine patients' overall well-being and the prevalence and predictors of medical, nutritional, an...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2015.5110
更新日期:2016-06-01 00:00:00
abstract:IMPORTANCE:Postoperative pulmonary complications can be a devastating consequence of surgery. Validated strategies to reduce these adverse outcomes are needed. OBJECTIVES:To design, implement, and determine the efficacy of a suite of interventions for reducing postoperative pulmonary complications. DESIGN:A before-af...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.358
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVES:To describe the current state of the science for operating room (OR) briefings and debriefings, including an overview of key definitions, a review of the evidence of effectiveness, and a summary of our experiences as part of a comprehensive unit-based safety program. OVERVIEW:Use of preoperative briefings h...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.172
更新日期:2014-08-01 00:00:00
abstract:Importance:There are currently 2 widely accepted treatment strategies for patients presenting to the hospital with choledocholithiasis. However, the rate of use for each strategy in the United States has not been evaluated, and their trends over time have not been described. Furthermore, an optimal management strategy ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.2059
更新日期:2016-12-01 00:00:00
abstract:Importance:There is limited literature reporting circumstances surrounding end-of-life care in vascular surgery patients. Objective:To identify factors driving end-of-life decisions in vascular surgery patients. Design, Setting, and Participants:In this cohort study, medical records were reviewed for all vascular sur...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.3970
更新日期:2017-02-01 00:00:00
abstract:IMPORTANCE:Patient- and hospital-level factors affecting outcomes after open and endovascular abdominal aortic aneurysm (AAA) repair are each well described separately, but not together. OBJECTIVE:To describe the association of patient- and hospital-level factors with in-hospital mortality after elective AAA repair. ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.0782
更新日期:2016-09-01 00:00:00
abstract:Importance:Medically treated symptomatic severe aortic stenosis has poor outcomes, and in the past 6 decades, it has successfully been treated with surgical aortic valve replacement (SAVR). However, one-third of patients with indications for SAVR are not offered surgery because of the high risk of complications. Transc...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2019.4449
更新日期:2019-11-27 00:00:00
abstract:Importance:Expansion of donor acceptance criteria for liver transplant increased the risk for early allograft failure (EAF), and although EAF prediction is pivotal to optimize transplant outcomes, there is no consensus on specific EAF indicators or timing to evaluate EAF. Recently, the Liver Graft Assessment Following ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.4095
更新日期:2020-12-01 00:00:00
abstract::Fibroepithelial lesions (FELs) are a common histologic finding on core needle biopsy (CNB) of the breast. Fibroepithelial lesions include fibroadenoma and phyllodes tumor, which can be difficult to distinguish with an initial CNB. An institutional experience was reviewed from February 12, 2001, to January 4, 2007, to ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.73
更新日期:2014-10-01 00:00:00
abstract:Importance:Surgical patient outcomes are related to surgeon skills. Objective:To measure resident surgeon technical and nontechnical skills for trauma core competencies before and after training and up to 18 months later and to compare resident performance with the performance of expert traumatologists. Design, Setti...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2017.0092
更新日期:2017-06-01 00:00:00
abstract:IMPORTANCE:Optimal duration of antibiotic treatment to reduce infectious complications after an appendectomy for acute complicated appendicitis remains unclear. OBJECTIVE:To investigate the effect of antibiotic duration on infectious complications after laparoscopic appendectomy for acute complicated appendicitis. DE...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2015.4236
更新日期:2016-04-01 00:00:00
abstract:IMPORTANCE:Trauma is known to be one of the strongest risk factors for pulmonary embolism (PE). Current guidelines recommend low-molecular-weight heparin therapy for prevention of PE, but trauma places some patients at risk of excess bleeding. Experts are divided on the role of prophylactic inferior vena cava (IVC) fil...
journal_title:JAMA surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1001/jamasurg.2013.3970
更新日期:2014-02-01 00:00:00
abstract:Importance:Growing consensus suggests that frailty-associated risks should inform shared surgical decision making. However, it is not clear how best to screen for frailty in preoperative surgical populations. Objective:To develop and validate the Risk Analysis Index (RAI), a 14-item instrument used to measure surgical...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.4202
更新日期:2017-02-01 00:00:00
abstract:Importance:The current staging system of gastric cancer is not adequate for defining a prognosis and predicting the patients most likely to benefit from chemotherapy. Objective:To construct a survival prediction model based on specific tumor and patient characteristics that enables individualized predictions of the ne...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2017.1087
更新日期:2017-07-19 00:00:00
abstract:IMPORTANCE:In an era of accountable care, understanding variation in health care costs is critical to reducing health care spending. OBJECTIVE:To identify factors associated with increased hospital costs and quantify variations in costs among individual hospitals in patients undergoing liver and pancreatic surgery in ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2015.3618
更新日期:2016-02-01 00:00:00
abstract:Importance:Whether computed tomography (CT) radiation is truly carcinogenic remains controversial. Large epidemiological studies that purportedly showed an association between CT radiation and carcinogenesis were limited by confounding by indication and reverse causation, because the reasons for CT examination were unk...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.6357
更新日期:2021-01-20 00:00:00
abstract:IMPORTANCE:Damage control (DC) with intra-abdominal packing and delayed reconstruction is an accepted strategy in trauma and acute care surgery but has not been evaluated in liver transplant. OBJECTIVE:To evaluate the incidence, effect on survival, and predictors of the need for DC using intra-abdominal packing and de...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2015.1853
更新日期:2015-11-01 00:00:00
abstract:IMPORTANCE:Hemorrhage is the leading cause of death in military trauma and second leading cause of death in civilian trauma. Although many well-established animal models of hemorrhage exist in the trauma and anticoagulant literature, few focus on directly quantitating blood loss. OBJECTIVE:To establish and validate a ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.1685
更新日期:2015-04-01 00:00:00
abstract:IMPORTANCE:The introduction of hepatoprotective strategies and multidisciplinary management has significantly improved the outcome of neonates with short bowel syndrome (SBS) who require parenteral nutrition (PN). OBJECTIVE:To determine the probability of weaning from PN based on intestinal length in neonates with SBS...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.4332
更新日期:2014-07-01 00:00:00
abstract:IMPORTANCE:Endovascular technology has become ubiquitous in the modern care of abdominal aortic aneurysm (AAA), yet broad estimates of its efficacy among variable hospital and regional settings is not known. OBJECTIVE:To perform a preliminary analysis of hospital effects on mortality following open AAA repair (OAR) an...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2014.3871
更新日期:2015-07-01 00:00:00
abstract:Importance:Investigating outcomes after marginal allograft transplant is essential in determining appropriate and more aggressive use of these allografts. Objective:To determine the time trends in the outcomes of marginal liver allografts as defined by 6 different sets of criteria. Design, Setting, and Participants:I...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.2484
更新日期:2020-08-05 00:00:00
abstract:Importance:In response to the burden of injury, the structure of injury care has changed considerably across Canada in the past decade. However, little is known about how patient outcomes have evolved. Objective:To evaluate trends in mortality, hospital length of stay, and unplanned readmission in Canadian trauma syst...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2016.4212
更新日期:2017-02-01 00:00:00
abstract:Importance:Resection of perihilar cholangiocarcinoma (PHC) is high-risk surgery, with reported operative mortality up to 17%. Therefore, preoperative risk assessment is needed to identify high-risk patients and anticipate postoperative adverse outcomes. Objective:To provide external validation of the Estimation of Phy...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.2305
更新日期:2016-12-01 00:00:00
abstract:IMPORTANCE:In recent years, the CD40/CD40L system has been implicated in the pathophysiology of severe chronic inflammatory diseases. Recently, obesity has been described as a low chronic inflammatory disease, so this system could also be involved in the inflammatory process. OBJECTIVE:To study soluble CD40 ligand (sC...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurgery.2013.419
更新日期:2013-02-01 00:00:00
abstract:IMPORTANCE:Individualized risk prediction tools have an important role as decision aids for use by patients and surgeons before surgery. Patient-centered outcomes should be incorporated into such tools to widen their appeal and improve their usability. OBJECTIVE:To develop a patient-centered outcome for the American C...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2014.3176
更新日期:2015-05-01 00:00:00
abstract:IMPORTANCE:Laparoscopic ventral hernia repair (LVHR) using mesh is a well-established intervention for ventral hernia, but pain control can be challenging. OBJECTIVE:To determine whether instillation of a long-acting local anesthetic between the mesh and the peritoneum after LVHR reduces pain or narcotic requirements....
journal_title:JAMA surgery
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamasurg.2015.1530
更新日期:2015-09-01 00:00:00