Risk Factors Analysis Of Intra-abdominal Infection After Laparoscopic Pancreaticoduodenectomy

BackgroundWith modern surgery entering the new era of minimally invasive surgery,laparoscopic pancreaticoduodenectomy(LPD)emerged and developed rapidly.Now,it is routinely performed in many hospitals.Intra-abdominal infection(IAI)is one of the common complications after LPD.Not only does IAI increase the risk of other postoperative complications,but it can also cause severe septic shock.All of these complications extend the length of hospital stay and increase the cost of treatment.Therefore,patients with IAI often have a poor prognosis.It is significant to explore the risk factors for IAI after LPD.Clinicians can develop effective and reasonable preventive measures based on these factors for patients to prevent the occurrence of IAI.That can effectively improve the prognosis of patients with LPD.MethodsWe collected 327 patients with standard LPD from the Department of Hepatobiliary and Pancreatic Surgery,First Hospital of Jilin University from January2019 to October 2020.We used statistical methods to retrospectively analyze these clinical data.Firstly,the factors that have statistical significance on the occurrence of IAI after LPD were screened by univariate analysis.Then,multivariate binary Logistic regression analysis was performed on statistically significant influencing factors to obtain independent risk factors.Finally,based on the independent risk factors,the ROC curve prediction model of the combined predictors was established to prevent the risk of IAI in high-risk patients.ResultsBy using unifactorial analysis of these clinical data,nine potential risk factors with statistical significance were identified,including smoking history,intraoperative bleeding over 500 ml,perioperative blood transfusion,pancreatic fistula,biliary fistula,postoperative bleeding,abdominal irrigation,drainage tube retention time over 7 days,and abdominal effusion.Bariate Logistic regression analysis of these nine potential factors showed that the independent risk factors for IAI after LPD were: smoking history(OR: 2.382,95%CI: 1.037～5.474,P= 0.041<0.05),intraoperative bleeding >500ml(OR: 7.039,95%CI: 1.668～29.698,P= 0.008<0.05),pancreatic fistula(OR: 4.528,95%CI: 2.013～10.183,P<0.001),peritoneal irrigation(OR: 4.468,95%CI: 1.360～14.678,P= 0.014&<0.05),postoperative bleeding(OR: 9.940,95%CI:2.210～44.710,P= 0.003<0.05),peritoneal effusion(OR: 4.902,95%CI: 2.151～11.172,P<0.001).The ROC curve risk prediction model of combined predictors was established by independent risk factors.The AUC was 0.876,which is close to 0.9 and indicated a high prediction accuracy.Conclusion1.The incidence of IAI after LPD is closely related to smoking history,surgical bleeding over 500 ml,pancreatic fistula,abdominal irrigation,postoperative bleeding,and abdominal effusion.Reducing the incidence of these related events can reduce the likelihood of IAI after LPD.2.The ROC curve prediction model obtained by independent risk factors has a good predictive value.According to the ROC curve,the risk of IAI in clinical patients after LPD can be evaluated through combined impact factors and the treatment measures can be taken for high-risk patients as soon as possible so as to prevent and treat high-risk patients as soon as possible.