Perioperative infection control and its effectiveness in hepatectomy patients.
OBJECTIVE
Post-hepatectomy infections require careful attention, because they may deteriorate into liver failure. We retrospectively reviewed such infections in cases without biliary or intestinal reconstruction.


METHODS
This retrospective study involved 535 patients with liver tumors who underwent hepatectomy at the Department of Gastroenterological Surgery of Yokohama City University Hospital between April 1992 and March 2005. After classification into four groups depending on changes in infection countermeasures used during different periods, the treatment outcomes were examined. No such anti-infection measures were taken during the first period; a closed suction drainage system and early enteral nutrition after surgery were introduced between the first and second periods; thorough management of bile leakage and prevention of nosocomial infection were added between the second and third periods; and surgical site infection (SSI) surveillance together with absorbable sutures instead of silk sutures between the third and fourth periods.


RESULTS
The incidence of postoperative infection decreased significantly with additional countermeasures: first period 44.7%; second period 24.1%; third period 15.0%; and fourth period 9.2%. The incidence of both SSI and remote infection were similarly reduced. Postoperative infection risk factors were age, presence of diabetes mellitus, the use of silk sutures and bile leakage, while those for SSI were the use of silk sutures and bile leakage.


CONCLUSIONS
The incidence of postoperative infection and SSI were significantly reduced by our infection countermeasures, especially by bile leakage management and the use of absorbable sutures.
Togo
Shinji
S
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan. togo@med.yokohama-cu.ac.jp
Matsuo
Kenichi
K
Tanaka
Kuniya
K
Matsumoto
Chizuru
C
Shimizu
Tetsuya
T
Ueda
Michio
M
Morioka
Daisuke
D
Nagano
Yasuhiko
Y
Endo
Itaru
I
Shimada
Hiroshi
H
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000150:complications; D048909:Diabetes Complications / Q000209:etiology; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D008113:Liver Neoplasms / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D013537:Sutures / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome