J. E. Taylor1, K. A. Morgan1 1Medical University Of South Carolina,Gastrointestinal And Laparoscopic Surgery,Charleston, Sc, USA
Introduction: Patients with chronic pancreatitis often have associated medical comorbidities prior to total pancreatectomy with islet cell autotransplantation (TPIAT). Predicting which patients may have an increased risk of certain complications is difficult. Long-term outcomes evaluating insulin use and quality of life have been evaluated in these patients. Little information has been published about the postoperative complications and the potential long-term implications.
Methods: A prospectively maintained database of 169 patients who underwent TPIAT at our institution from March 2009 to April 2016 was retrospectively reviewed. Interest was given to development of Clostridium difficile infection (CDI) following surgery and the determination of time to diagnosis after surgery. Pre-operative risk factors were analyzed. Charts were reviewed for postoperative complications, including pneumonia, urinary tract infection (UTI), biliary leak, portal vein thrombosis, as well as long-term mortality.
Results: A total of 17 patients (10.1%) developed C. difficile infection following TPIAT. A binary logistic regression analysis of pre-operative factors was performed on the patients who developed C difficile infection. Of the factors in the analysis, history of alcohol abuse (P = 0.025), diabetes (P = 0.016), previous emergency department visits (P = 0.004), previous hospitalizations (P = 0.009), enteral nutrition requirement (P = 0.046), and daily morphine use (P = 0.043) were found to be statistically significant (P < 0.05). Postoperative complications found to be associated with the development of C. difficile infection include greater ICU length of stay and pneumonia.
Conclusion: Following TPIAT at our institution, there is an increased rate of C. difficile infection compared to the overall rate of development within our hospital. Several pre-operative risk factors in the patient population have been associated with the contraction of C. difficile postoperatively. Knowledge of these factors may aid in the development of new protocols preoperatively to help minimize the risk that these elements have on this patient population.