A. T. Nguyen2, Z. M. Dong2, J. W. Marsh1, A. Tsung1 1University Of Pittsburgh,Department Of Surgery,Pittsburgh, PA, USA 2University Of Pittsburgh,School Of Medicine,Pittsburgh, PA, USA
Introduction: Pancreaticobiliary and duodenal tumors often present with obstructive pathology and require invasive procedures for therapeutic and diagnostic purposes such as ERCP or endoscopic biopsy. Currently, there is no evidence favoring inpatient versus outpatient intervention. Though admission for these procedures may be more convenient for providers, it may also predispose patients to microbial colonization and consequent infection. The purpose of this study is to evaluate the relationship between inpatient and outpatient preoperative management and postoperative infection.
Methods: This retrospective cohort study includes 301 patients who underwent pancreaticoduodenectomy from 2012 to 2015. Demographic, preoperative care and tumor characteristic data were collected. All patients underwent either endoscopic biopsy, ERCP, or PTC prior to surgery. Patients were categorized as inpatients or outpatients based on the setting of preoperative intervention 180 days prior to surgery. Chi-square, Mann-Whitney U, univariable and multivariable logistic regression were carried out with Stata 14. Adjustment variables had p-values less than 0.2.
Results: Of the 301 patients 34.9% were outpatients and 65.1% were inpatients. The groups did not differ in prevalence of diabetes, hypertension, coronary artery disease, age, sex or type of cancer. The primary outcome was postoperative infection subdivided into specific infection type. The rate of all postoperative infections was 45.8% and not significantly different between groups (p = 0.45). Of the infection subtypes, SSI significantly differed and occurred in 20.9% of outpatients versus 32.7% of inpatients (p = 0.032). In univariable logistic regression for SSI, inpatient status had an OR of 1.83 (95% CI 1.05 – 3.19, p = .034). The multivariable model adjusted for tumor size, stage and type of preoperative intervention. In multivariable logistic regression for SSI, inpatient status had an adjusted OR of 1.74 (95% CI 0.95 – 3.18, p = .071). No adjustment variables were significantly related to SSI.
Conclusion: Inpatient invasive care prior to pancreaticoduodenectomy was associated with a significant increase in postoperative surgical site infection. This suggests that patients with pancreaticobiliary and duodenal cancers should receive outpatient workup whenever possible to reduce postoperative morbidity.