Risk Factors Of Infection After Pancreaticoduodenectomy

Objective: To analyse the risk factors associated with postoperative infection of pancreaticoduodenectomy(PD) and explore preventive measures to reduce the incidence of the postoperative infection in clinic.Method: One hundred and forty-five patients who underwent PD at the Second Affiliated Hospital of Dalian Medical University from January 2008 to December 2014 were reviewed retrospectively. According to the patients with infection after PD or not,they were divided into infection group(32 cases) and the control group(113 cases).Single factor and Two yuan logistics regression analysis statistical method were used to analyze the general information, preoperative, intraoperative and postoperative factors of patients in two groups. If P<0.05, we believe that the difference was statistically significant. Logistic regression analysis was carried out on the statistically significant factors, we believe these factors were independent risk factors which left in the Logistic regression model.Result: There were collected 145 cases of patients with PD and male 87 cases(60.0%),female 58 cases(40.0%), aged from37 to 79 years old. A total of 32 patients with infection, abdominal infections 18 cases(12.4%, 18/145), mean age(62.84±9.67)years old. Respiratory tract infection in 14 patients(9.7%, 14/145), wound infection in 3 cases(2.1%, 3/145), urinary infection in 1 case(0.7%, 1/145) and deep venous catheter infection in one case(0.7%, 1/145).,6 cases with multi-system infection. In the infected group patients, the average age was(64.91±7.55) years old, 16 male patients and 16 female patients, the average weight was(64.42±12.40) kg, 5 patients had preoperative jaundice drainage(15.63%), preoperative biochemical indices ALT128.00U/L,AST86.00U/L, preoperative albumin(39.60±4.63)g/L and CA19966.85U/ml, 13 patients with diabetes, preoperative median serum total bilirubin was 202.90μmol/L,blood loss in operation median was 400 ml, there were 7 patients were intraoperative blood transfusion, mean operative time(6.50±1.48) h, mean postoperative hemoglobin(111.72 ±19.08)g/L, mean postoperative albumin(26.64±6.01)g/L. In control group patients, mean age was(62.27±10.15) years old, 71 male cases, 42 female cases, average body weight(60.65±9.63)kg, 13 cases had preoperative jaundice drainage(11.50%),preoperative biochemical indicators ALT178.16U/L, AST114.00U/L, preoperative albumin(38.49±6.17)g/L and CA199 109.20u/ml, 18 cases with diabetes, preoperative serum total bilirubin median were 90.75μmol/L, blood loss in operation median was400 ml,there were 7 patients were intraoperative blood transfusion, mean operative time(5.74±1.60)h, mean postoperative hemoglobin(107.21±19.34)g/L, mean postoperative albumin(31.54±5.63) g/L. Single factor analysis showed that preoperative total bilirubin, diabetes, operation time, postoperative albumin, postoperative pancreatic fistula, postoperative delayed gastric emptying were different significance(P<0.05).Two yuan logistics regression analysis showed that preoperative total bilirubin,postoperative hyperglycemia, post-operative albumin, postoperative pancreatic fistula were independent risk factors of infection after PD(P<0.05).Conclusion: Preoperative total bilirubin, diabetes, postoperative albumin,postoperative pancreatic fistula were independent risk factors of infection after PD.According to the main risk factors lead to infection, appropriate perioperative management may reduce the dangerous of patients after PD.