Risk factors for postoperative pneumonia after hepatectomy with extrahepatic bile duct resection.

BACKGROUND: The present study investigated the incidence of postoperative pneumonia (POP) after hepatectomy with extrahepatic bile duct resection (BDR) and elucidated risk factors for POP. METHODS: A total of 257 patients undergoing hepatectomy with BDR between 2011 and 2019 were retrospectively reviewed to evaluate the incidence of POP, defined by the Clavien-Dindo grade ≥ II. The predictive factors for POP were identified using logistic regression analysis of the pre- and intraoperative evaluable factors. RESULTS: Postoperative pneumonia developed in 15 patients (5.8%), diagnosed as grade IV or V in five patients. In a multivariate analysis, a vital capacity ratio (%VC) <80% (odds ratio [OR] 7.30, P = .005), age ≥ 74 years old (OR 5.39, P = .026), and future liver volume remnant (FLR) ratio ≤ 40% (OR 4.97, P = .045) were independent risk factors for POP. Among patients with performing spirometry, the incidence of developing POP was 1.0%, 8.8%, and 60% in patients with 0, 1-2, and 3 risk factors, respectively. CONCLUSIONS: The incidence of POP in patients undergoing hepatectomy with BDR was 5.8%. A %VC <80%, age ≥74 years old, and FLR ratio ≤40% were identified as preoperative predictive factors of developing POP.

Changes in the body composition and nutritional status after total pancreatectomy.

PURPOSE: The purpose of this study was to evaluate changes in the body composition and nutritional status after total pancreatectomy (TP). METHODS: Consecutive 45 patients underwent TP between February 2003 and July 2018. Among them, 32 had computed tomography images available before TP and at 6 and 12 months after TP. The skeletal muscle index (SMI), visceral fat tissue index (VFI), and subcutaneous fat tissue index (SFI) were measured using images at each time. Body mass index (BMI), serum albumin levels (Alb), hemoglobin A1c levels (HbA1c), and daily insulin use were also recorded. RESULTS: There were significant reductions in SMI (median, 38.7 vs. 36.6 cm2/m2, P = 0.030), VFI (12.4 vs. 5.1 cm2/m2, P < 0.001), SFI (26.5 vs. 9.2 cm2/m2, P < 0.001), BMI (20.3 vs. 18.7 kg/m2, P < 0.001), and Alb (4.2 vs. 3.7 g/dL, P = 0.031) at 6 months after TP compared with preoperative period. HbA1c significantly increased at 6 months after TP compared with postoperative discharge (6.7 vs. 7.3%, P < 0.001). The daily insulin use significantly increased at 12 months after TP compared with 6 months after TP (22 vs. 26 units/day, P < 0.001), whereas there were no significant changes in other parameters. CONCLUSIONS: Significant losses in fat and skeletal muscle mass as well as the BMI and Alb occurred within the first 6 months after TP. A subsequent increase in the daily insulin use occurred during the next six months, which helped preserve the body composition.