Antibiotic irrigation during pancreatoduodenectomy to prevent infection and pancreatic fistula: A randomized controlled clinical trial

Thomas K. Maatman, Daniel J. Weber, Lava R. Timsina, Beenish Qureshi, Eugene P. Ceppa, Attila Nakeeb, C. Max Schmidt, Nicholas J. Zyromski, Leonidas G. Koniaris, Michael G. House

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Surgical site infection affects 25% of patients undergoing pancreatoduodenectomy. This double-blind, randomized controlled trial tested the efficacy of intraperitoneal antibiotic irrigation in decreasing infection and pancreatic fistula after pancreatoduodenectomy. Methods: Patients undergoing pancreatoduodenectomy were randomized (1:1 ratio) to intraperitoneal antibiotic (polymyxin B, 500,000 units/L) irrigation or 0.9% NaCl irrigation. All patients received 1 dose of standard parenteral antibiotics within 1 hour of incision. The trial was powered to detect a 15% difference in any surgical site infection (primary endpoint) within 30 days after pancreatoduodenectomy. Results: One hundred ninety patients undergoing pancreatoduodenectomy were randomized: 95 to antibiotic irrigation and 95 to saline irrigation. Groups were well matched regarding demographics, diagnosis, preoperative biliary stenting, bactibilia, texture of the pancreatic parenchyma, pancreatic and bile duct size, portal vein resection, and anastomotic technique. Overall, 30-day surgical site infection was observed in 24 (13%) patients: antibiotic irrigation in 10 (11%) versus saline in 14 (15%) (P =.62). Superficial (n = 9, 5%) and organ-space (n = 15, 8%) surgical site infection rates were 3% and 7% (antibiotic) and 6% and 8% (saline), respectively (P >.31). Clinically relevant postoperative pancreatic fistula occurred in 11 (12%) patients in the antibiotic arm and 10 (11%) in saline controls (P >.95). Conclusion: The addition of antibiotic solution to intraperitoneal irrigation does not decrease the incidence of postoperative infectious complications or pancreatic fistula after pancreatoduodenectomy.

Original languageEnglish (US)
Pages (from-to)469-475
Number of pages7
JournalSurgery (United States)
Volume166
Issue number4
DOIs
StatePublished - Oct 2019

Fingerprint

Pancreatic Fistula
Pancreaticoduodenectomy
Randomized Controlled Trials
Anti-Bacterial Agents
Surgical Wound Infection
Infection
Polymyxin B
Pancreatic Ducts
Portal Vein
Bile Ducts
Demography
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Antibiotic irrigation during pancreatoduodenectomy to prevent infection and pancreatic fistula : A randomized controlled clinical trial. / Maatman, Thomas K.; Weber, Daniel J.; Timsina, Lava R.; Qureshi, Beenish; Ceppa, Eugene P.; Nakeeb, Attila; Schmidt, C. Max; Zyromski, Nicholas J.; Koniaris, Leonidas G.; House, Michael G.

In: Surgery (United States), Vol. 166, No. 4, 10.2019, p. 469-475.

Research output: Contribution to journalArticle

@article{e8803479fc01406e88b5eb85876f0419,
title = "Antibiotic irrigation during pancreatoduodenectomy to prevent infection and pancreatic fistula: A randomized controlled clinical trial",
abstract = "Background: Surgical site infection affects 25{\%} of patients undergoing pancreatoduodenectomy. This double-blind, randomized controlled trial tested the efficacy of intraperitoneal antibiotic irrigation in decreasing infection and pancreatic fistula after pancreatoduodenectomy. Methods: Patients undergoing pancreatoduodenectomy were randomized (1:1 ratio) to intraperitoneal antibiotic (polymyxin B, 500,000 units/L) irrigation or 0.9{\%} NaCl irrigation. All patients received 1 dose of standard parenteral antibiotics within 1 hour of incision. The trial was powered to detect a 15{\%} difference in any surgical site infection (primary endpoint) within 30 days after pancreatoduodenectomy. Results: One hundred ninety patients undergoing pancreatoduodenectomy were randomized: 95 to antibiotic irrigation and 95 to saline irrigation. Groups were well matched regarding demographics, diagnosis, preoperative biliary stenting, bactibilia, texture of the pancreatic parenchyma, pancreatic and bile duct size, portal vein resection, and anastomotic technique. Overall, 30-day surgical site infection was observed in 24 (13{\%}) patients: antibiotic irrigation in 10 (11{\%}) versus saline in 14 (15{\%}) (P =.62). Superficial (n = 9, 5{\%}) and organ-space (n = 15, 8{\%}) surgical site infection rates were 3{\%} and 7{\%} (antibiotic) and 6{\%} and 8{\%} (saline), respectively (P >.31). Clinically relevant postoperative pancreatic fistula occurred in 11 (12{\%}) patients in the antibiotic arm and 10 (11{\%}) in saline controls (P >.95). Conclusion: The addition of antibiotic solution to intraperitoneal irrigation does not decrease the incidence of postoperative infectious complications or pancreatic fistula after pancreatoduodenectomy.",
author = "Maatman, {Thomas K.} and Weber, {Daniel J.} and Timsina, {Lava R.} and Beenish Qureshi and Ceppa, {Eugene P.} and Attila Nakeeb and Schmidt, {C. Max} and Zyromski, {Nicholas J.} and Koniaris, {Leonidas G.} and House, {Michael G.}",
year = "2019",
month = "10",
doi = "10.1016/j.surg.2019.05.053",
language = "English (US)",
volume = "166",
pages = "469--475",
journal = "Surgery",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Antibiotic irrigation during pancreatoduodenectomy to prevent infection and pancreatic fistula

T2 - A randomized controlled clinical trial

AU - Maatman, Thomas K.

AU - Weber, Daniel J.

AU - Timsina, Lava R.

AU - Qureshi, Beenish

AU - Ceppa, Eugene P.

AU - Nakeeb, Attila

AU - Schmidt, C. Max

AU - Zyromski, Nicholas J.

AU - Koniaris, Leonidas G.

AU - House, Michael G.

PY - 2019/10

Y1 - 2019/10

N2 - Background: Surgical site infection affects 25% of patients undergoing pancreatoduodenectomy. This double-blind, randomized controlled trial tested the efficacy of intraperitoneal antibiotic irrigation in decreasing infection and pancreatic fistula after pancreatoduodenectomy. Methods: Patients undergoing pancreatoduodenectomy were randomized (1:1 ratio) to intraperitoneal antibiotic (polymyxin B, 500,000 units/L) irrigation or 0.9% NaCl irrigation. All patients received 1 dose of standard parenteral antibiotics within 1 hour of incision. The trial was powered to detect a 15% difference in any surgical site infection (primary endpoint) within 30 days after pancreatoduodenectomy. Results: One hundred ninety patients undergoing pancreatoduodenectomy were randomized: 95 to antibiotic irrigation and 95 to saline irrigation. Groups were well matched regarding demographics, diagnosis, preoperative biliary stenting, bactibilia, texture of the pancreatic parenchyma, pancreatic and bile duct size, portal vein resection, and anastomotic technique. Overall, 30-day surgical site infection was observed in 24 (13%) patients: antibiotic irrigation in 10 (11%) versus saline in 14 (15%) (P =.62). Superficial (n = 9, 5%) and organ-space (n = 15, 8%) surgical site infection rates were 3% and 7% (antibiotic) and 6% and 8% (saline), respectively (P >.31). Clinically relevant postoperative pancreatic fistula occurred in 11 (12%) patients in the antibiotic arm and 10 (11%) in saline controls (P >.95). Conclusion: The addition of antibiotic solution to intraperitoneal irrigation does not decrease the incidence of postoperative infectious complications or pancreatic fistula after pancreatoduodenectomy.

AB - Background: Surgical site infection affects 25% of patients undergoing pancreatoduodenectomy. This double-blind, randomized controlled trial tested the efficacy of intraperitoneal antibiotic irrigation in decreasing infection and pancreatic fistula after pancreatoduodenectomy. Methods: Patients undergoing pancreatoduodenectomy were randomized (1:1 ratio) to intraperitoneal antibiotic (polymyxin B, 500,000 units/L) irrigation or 0.9% NaCl irrigation. All patients received 1 dose of standard parenteral antibiotics within 1 hour of incision. The trial was powered to detect a 15% difference in any surgical site infection (primary endpoint) within 30 days after pancreatoduodenectomy. Results: One hundred ninety patients undergoing pancreatoduodenectomy were randomized: 95 to antibiotic irrigation and 95 to saline irrigation. Groups were well matched regarding demographics, diagnosis, preoperative biliary stenting, bactibilia, texture of the pancreatic parenchyma, pancreatic and bile duct size, portal vein resection, and anastomotic technique. Overall, 30-day surgical site infection was observed in 24 (13%) patients: antibiotic irrigation in 10 (11%) versus saline in 14 (15%) (P =.62). Superficial (n = 9, 5%) and organ-space (n = 15, 8%) surgical site infection rates were 3% and 7% (antibiotic) and 6% and 8% (saline), respectively (P >.31). Clinically relevant postoperative pancreatic fistula occurred in 11 (12%) patients in the antibiotic arm and 10 (11%) in saline controls (P >.95). Conclusion: The addition of antibiotic solution to intraperitoneal irrigation does not decrease the incidence of postoperative infectious complications or pancreatic fistula after pancreatoduodenectomy.

UR - http://www.scopus.com/inward/record.url?scp=85072718219&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072718219&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2019.05.053

DO - 10.1016/j.surg.2019.05.053

M3 - Article

C2 - 31383465

AN - SCOPUS:85072718219

VL - 166

SP - 469

EP - 475

JO - Surgery

JF - Surgery

SN - 0039-6060

IS - 4

ER -