title: Preoperative biliary drainage does not increase major complications in pancreaticoduodenectomy: a large single center experience from the Massachusetts General Hospital.
abstract: BACKGROUND
  The impact of preoperative biliary drainage (PBD) on perioperative morbidity and mortality in pancreatic surgery is still under debate. The aim of this study was to investigate outcomes of stented vs. non-stented patients undergoing pancreatoduodenectomy (PD).
  
  
  METHODS
  We retrospectively compared 500 consecutive patients who underwent PBD prior to PD with 500 patients who did not. Ninety-day mortality and morbidity were assessed.
  
  
  RESULTS
  The overall postoperative morbidity and mortality was 37% and 1.4%, respectively. Major complications (Clavien ≥ III) occurred in 16% of patients. The overall morbidity and mortality was not significantly higher in patients who underwent PBD. However, the rate of wound infection was significantly higher in patients who underwent PBD (19% vs. 9%, P = 0.001). When comparing intraoperative bile cultures of stented patients with and without wound infection, the presence of Enterobacter species (OR 2.4, 95% CI 1.5-4.1, P = 0.001) and Citrobacter species (OR 2.3, 95% CI 1.1-5.2, P = 0.037) in the bile significantly increased the likelihood of wound infection.
  
  
  CONCLUSIONS
  Preoperative biliary drainage is associated with bactobilia and wound infection, but does not affect the overall morbidity and mortality of patients undergoing PD.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Wang Ambulatory Care Center 460, 15 Parkman Street, Boston, MA 02114, USA.
authors.forename: Klaus
authors.initials: K
authors.lastname: Sahora
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Wang Ambulatory Care Center 460, 15 Parkman Street, Boston, MA 02114, USA.
authors.forename: Vicente
authors.initials: V
authors.lastname: Morales-Oyarvide
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Wang Ambulatory Care Center 460, 15 Parkman Street, Boston, MA 02114, USA.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ferrone
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Wang Ambulatory Care Center 460, 15 Parkman Street, Boston, MA 02114, USA.
authors.forename: Zhi Ven
authors.initials: ZV
authors.lastname: Fong
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Wang Ambulatory Care Center 460, 15 Parkman Street, Boston, MA 02114, USA.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Warshaw
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Wang Ambulatory Care Center 460, 15 Parkman Street, Boston, MA 02114, USA.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Wang Ambulatory Care Center 460, 15 Parkman Street, Boston, MA 02114, USA. cfernandez@partners.org.
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernández-del Castillo
mesh_terms: D000368:Aged; D004322:Drainage / Q000379:methods*; D005260:Female; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011300:Preoperative Care; D012189:Retrospective Studies
keywords: Drainage; Morbidity; Pancreas; Pancreaticoduodenectomy; Surgery