Preoperative Risk Factor Analysis and Prognosis of Sepsis After Elective Hepatobiliary and Pancreatic Surgery
PURPOSE: We aimed to analyze the risk factor of sepsis after hepatobiliary and pancreatic surgery and to investigate the prognosis. METHODS：The subjects were retrospectively studied from the database for hepatobiliary and pancreatic surgery cases, who had undergone a surgical operation at Tohoku Uni...
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| Published in | Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 38; no. 4; pp. 635 - 641 |
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| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japanese Society for Abdominal Emergency Medicine
31.05.2018
日本腹部救急医学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem.38.635 |
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| Abstract | PURPOSE: We aimed to analyze the risk factor of sepsis after hepatobiliary and pancreatic surgery and to investigate the prognosis. METHODS：The subjects were retrospectively studied from the database for hepatobiliary and pancreatic surgery cases, who had undergone a surgical operation at Tohoku University Hospital and Tohoku Rosai Hospital from 2011 to 2015. RESULTS：A total of 523 cases were reviewed. The sepsis rates were 6％, 16％, 10％, 33％ and 56％ in pancreaticoduodenectomy (PD), hepatectomy, total pancreatectomy, distal pancreatectomy combined with celiac axis resection, and hepato-pancreaticoduodenectomy, respectively. In the PD group, it was found that the low value of hemoglobin was a risk factor, and in the hepatectomy group, a prolonged activated partial thromboplastin time (APTT) was a risk factor. Regarding the long-term prognosis, when the overall survival rate was examined except for 90-day mortality with sepsis cases and benign diseases, sepsis cases showed a poor prognosis in the hepatectomy group. CONCLUSIONS: Because sepsis might have a relationship with the long-term prognosis, highly invasive surgery for hepatobiliary and pancreatic surgery requires postoperative management based on the preoperative risk factors with sepsis in mind. |
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| AbstractList | PURPOSE: We aimed to analyze the risk factor of sepsis after hepatobiliary and pancreatic surgery and to investigate the prognosis. METHODS：The subjects were retrospectively studied from the database for hepatobiliary and pancreatic surgery cases, who had undergone a surgical operation at Tohoku University Hospital and Tohoku Rosai Hospital from 2011 to 2015. RESULTS：A total of 523 cases were reviewed. The sepsis rates were 6％, 16％, 10％, 33％ and 56％ in pancreaticoduodenectomy (PD), hepatectomy, total pancreatectomy, distal pancreatectomy combined with celiac axis resection, and hepato-pancreaticoduodenectomy, respectively. In the PD group, it was found that the low value of hemoglobin was a risk factor, and in the hepatectomy group, a prolonged activated partial thromboplastin time (APTT) was a risk factor. Regarding the long-term prognosis, when the overall survival rate was examined except for 90-day mortality with sepsis cases and benign diseases, sepsis cases showed a poor prognosis in the hepatectomy group. CONCLUSIONS: Because sepsis might have a relationship with the long-term prognosis, highly invasive surgery for hepatobiliary and pancreatic surgery requires postoperative management based on the preoperative risk factors with sepsis in mind. PURPOSE: We aimed to analyze the risk factor of sepsis after hepatobiliary and pancreatic surgery and to investigate the prognosis. METHODS：The subjects were retrospectively studied from the database for hepatobiliary and pancreatic surgery cases, who had undergone a surgical operation at Tohoku University Hospital and Tohoku Rosai Hospital from 2011 to 2015. RESULTS：A total of 523 cases were reviewed. The sepsis rates were 6％, 16％, 10％, 33％ and 56％ in pancreaticoduodenectomy (PD), hepatectomy, total pancreatectomy, distal pancreatectomy combined with celiac axis resection, and hepato-pancreaticoduodenectomy, respectively. In the PD group, it was found that the low value of hemoglobin was a risk factor, and in the hepatectomy group, a prolonged activated partial thromboplastin time (APTT) was a risk factor. Regarding the long-term prognosis, when the overall survival rate was examined except for 90-day mortality with sepsis cases and benign diseases, sepsis cases showed a poor prognosis in the hepatectomy group. CONCLUSIONS: Because sepsis might have a relationship with the long-term prognosis, highly invasive surgery for hepatobiliary and pancreatic surgery requires postoperative management based on the preoperative risk factors with sepsis in mind. 【目的】待機的な肝胆膵術後敗血症の術前リスク因子を解析すること，および敗血症の予後に対する影響を検討することを目的とした。【方法】対象は2011年から2015年に東北大学病院あるいは東北労災病院で肝胆膵手術を施行した症例を対象とし，後向きに検討した。【結果】全症例は523例であり，敗血症発症率は膵頭十二指腸切除術，肝切除群，膵全摘群，腹腔動脈合併尾側膵切除術，肝膵十二指腸切除群でそれぞれ，6％，16％，10％，33％，56％であった。リスク因子の検討では，膵頭十二指腸切除術群はヘモグロビン12.8g/dL以下，肝切除群ではAPTT 33.6秒以上がリスク因子であることがわかった。敗血症発症から90日未満死亡例と良性例を除き全生存率を検討すると，肝切除群において敗血症例が予後不良であった。【結語】敗血症は長期予後も不良にするため，肝胆膵手術には敗血症を念頭に置いた周術期管理が必要である。 |
| Author | Katayose, Yu Mutoh, Mitsuhisa Motoi, Fuyuhiko Ise, Ichiro Morikawa, Takanori Hayashi, Hiroki Nakagawa, Kei Unno, Michiaki Mizuma, Masamichi Ohtsuka, Hideo Tokumura, Hiromi Naitoh, Takeshi |
| Author_FL | 大塚 英郎 水間 正道 片寄 友 伊勢 一郎 武藤 満完 森川 孝則 林 洋毅 中川 圭 元井 冬彦 海野 倫明 徳村 弘実 内藤 剛 |
| Author_FL_xml | – sequence: 1 fullname: 片寄 友 – sequence: 2 fullname: 伊勢 一郎 – sequence: 3 fullname: 林 洋毅 – sequence: 4 fullname: 中川 圭 – sequence: 5 fullname: 森川 孝則 – sequence: 6 fullname: 水間 正道 – sequence: 7 fullname: 大塚 英郎 – sequence: 8 fullname: 武藤 満完 – sequence: 9 fullname: 徳村 弘実 – sequence: 10 fullname: 元井 冬彦 – sequence: 11 fullname: 内藤 剛 – sequence: 12 fullname: 海野 倫明 |
| Author_xml | – sequence: 1 fullname: Katayose, Yu organization: Hepatobiliary and Pancreatic Surgery, Tohoku Medical and Pharmaceutical University – sequence: 1 fullname: Nakagawa, Kei organization: Department of Surgery, Tohoku University Graduate School of Medicine – sequence: 1 fullname: Mutoh, Mitsuhisa organization: Department of Surgery, Tohoku Rosai Hospital – sequence: 1 fullname: Motoi, Fuyuhiko organization: Department of Surgery, Tohoku University Graduate School of Medicine – sequence: 1 fullname: Unno, Michiaki organization: Department of Surgery, Tohoku University Graduate School of Medicine – sequence: 1 fullname: Naitoh, Takeshi organization: Department of Surgery, Tohoku University Graduate School of Medicine – sequence: 1 fullname: Mizuma, Masamichi organization: Department of Surgery, Tohoku University Graduate School of Medicine – sequence: 1 fullname: Hayashi, Hiroki organization: Department of Surgery, Tohoku University Graduate School of Medicine – sequence: 1 fullname: Ise, Ichiro organization: Department of Surgery, Tohoku University Graduate School of Medicine – sequence: 1 fullname: Ohtsuka, Hideo organization: Department of Surgery, Tohoku University Graduate School of Medicine – sequence: 1 fullname: Tokumura, Hiromi organization: Department of Surgery, Tohoku Rosai Hospital – sequence: 1 fullname: Morikawa, Takanori organization: Department of Surgery, Tohoku University Graduate School of Medicine |
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| PublicationTitle_FL | J Abdom Emerg Med 日本腹部救急医学会雑誌 日腹部救急医会誌 Journal of Abdominal Emergency Medicine Nihon Fukubu Kyukyu Igakkai Zasshi |
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| References | 13) Krarup PM, Nordholm-Carstensen A, Jorgensen LN, et al: Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Ann Surg 2014: 259: 930-938. 7) Kimura F, Shimizu H, Yoshidome H, et al: Immunosuppression following surgical and traumatic injury. Surg Today 2010; 40: 793-808. 3) Chen Y, Ou G, Lian G, et al: Effect of Preoperative Biliary Drainage on Complications Following Pancreatoduodenectomy: A Meta-Analysis. Medicine （Baltimore） 2015; 94: e1199. 11) Bassi C, Dervenis C, Butturini G, et al: Postoperative pancreatic fistula: An international study group (ISGPF) definition. Surgery 2005; 138: 8-13. 1) Coelen RJ, Wiggers JK, Nio CY, et al: Preoperative computed tomography assessment of skeletal muscle mass is valuable in predicting outcomes following hepatectomy for perihilar cholangiocarcinoma. HPB （Oxford） 2015; 17: 520-528. 5) Kenjo A, Miyata H, Gotoh M, et al: Risk stratification of 7,732 hepatectomy cases in 2011 from the National Clinical Database for Japan. J Am Coll Surg 2014; 218: 412-422. 4) Kimura W, Miyata H, Gotoh M, et al: A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population （Japanese）using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg 2014; 259: 773-780. 8) Oda S, Aibiki M, Ikeda T, et al: Sepsis Registry Committee of The Japanese Society of Intensive Care Medicine. The Japanese guidelines for the management of sepsis. J Intensive Care 2014; 2: 55. 6) Caine GJ, Stonelake PS, Lip GY, et al: The hypercoagulable state of malignancy: pathogenesis and current debate. Neoplasia 2002; 4: 465-473. 10) Bateman BT, Schmidt U, Berman MF, et al: Temporal trends in the epidemiology of severe postoperative sepsis after elective surgery: a large, nationwide sample. Anesthesiology 2010; 112: 917-925. 12) Tai LH, Ananth AA, Seth R, et al: Sepsis increases perioperative metastases in a murine model. BMC Cancer 2018; 18: 277. 9) MacQueen IT, Dawes AJ, Hadnott T, et al: Use of a Hospital-Wide Screening Program for Early Detection of Sepsis in General Surgery Patients. Am Surg 2015; 81: 1074-1079. 2) Narita M, Oussoultzoglou E, Fuchshuber P, et al: What is a safe future liver remnant size in patients undergoing major hepatectomy for colorectal liver metastases and treated by intensive preoperative chemotherapy? Ann Surg Oncol 2012; 19: 2526-2538. 14) Mirnezami A, Mirnezami R, Chandrakumaran K, et al: Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 2011; 253: 890-899. |
| References_xml | – reference: 11) Bassi C, Dervenis C, Butturini G, et al: Postoperative pancreatic fistula: An international study group (ISGPF) definition. Surgery 2005; 138: 8-13. – reference: 3) Chen Y, Ou G, Lian G, et al: Effect of Preoperative Biliary Drainage on Complications Following Pancreatoduodenectomy: A Meta-Analysis. Medicine （Baltimore） 2015; 94: e1199. – reference: 14) Mirnezami A, Mirnezami R, Chandrakumaran K, et al: Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 2011; 253: 890-899. – reference: 12) Tai LH, Ananth AA, Seth R, et al: Sepsis increases perioperative metastases in a murine model. BMC Cancer 2018; 18: 277. – reference: 8) Oda S, Aibiki M, Ikeda T, et al: Sepsis Registry Committee of The Japanese Society of Intensive Care Medicine. The Japanese guidelines for the management of sepsis. J Intensive Care 2014; 2: 55. – reference: 9) MacQueen IT, Dawes AJ, Hadnott T, et al: Use of a Hospital-Wide Screening Program for Early Detection of Sepsis in General Surgery Patients. Am Surg 2015; 81: 1074-1079. – reference: 10) Bateman BT, Schmidt U, Berman MF, et al: Temporal trends in the epidemiology of severe postoperative sepsis after elective surgery: a large, nationwide sample. Anesthesiology 2010; 112: 917-925. – reference: 1) Coelen RJ, Wiggers JK, Nio CY, et al: Preoperative computed tomography assessment of skeletal muscle mass is valuable in predicting outcomes following hepatectomy for perihilar cholangiocarcinoma. HPB （Oxford） 2015; 17: 520-528. – reference: 4) Kimura W, Miyata H, Gotoh M, et al: A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population （Japanese）using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg 2014; 259: 773-780. – reference: 7) Kimura F, Shimizu H, Yoshidome H, et al: Immunosuppression following surgical and traumatic injury. Surg Today 2010; 40: 793-808. – reference: 2) Narita M, Oussoultzoglou E, Fuchshuber P, et al: What is a safe future liver remnant size in patients undergoing major hepatectomy for colorectal liver metastases and treated by intensive preoperative chemotherapy? Ann Surg Oncol 2012; 19: 2526-2538. – reference: 13) Krarup PM, Nordholm-Carstensen A, Jorgensen LN, et al: Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Ann Surg 2014: 259: 930-938. – reference: 5) Kenjo A, Miyata H, Gotoh M, et al: Risk stratification of 7,732 hepatectomy cases in 2011 from the National Clinical Database for Japan. J Am Coll Surg 2014; 218: 412-422. – reference: 6) Caine GJ, Stonelake PS, Lip GY, et al: The hypercoagulable state of malignancy: pathogenesis and current debate. Neoplasia 2002; 4: 465-473. |
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| SubjectTerms | リスク因子 予後 敗血症 肝胆膵手術 |
| Title | Preoperative Risk Factor Analysis and Prognosis of Sepsis After Elective Hepatobiliary and Pancreatic Surgery |
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