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Objective: Compare the effectiveness of 1st-3rd generation cephalosporins (1st-3rdCE) to broad-spectrum antibiotics in decreasing surgical site infections (SSI) after pancreatectomy. Summary of Background Data: SSI is one of the most common complications after pancreatic surgery. Various antibiotic regimens are utilized nationwide with no clear guidelines for pancreatectomy. As we await results of a recently initiated prospective trial, this study retrospectively evaluates over 15,000 patients using the same administrative data abstraction tools as in the trial. Methods: All relevant clinical variables were collected from the 2016–2018 targeted-pancreatectomy database from the American College of Surgeon National Surgical Quality Improvement Program. Preoperative antibiotics were initially collected as first-generation cephalosporin, second or third-generation cephalosporin, and broad-spectrum antibiotics (Broad-abx). Results: Of the 15,182 patients who completed a pancreatic surgery between 2016 and 2018, 6114 (40%) received a first-generation cephalosporin, 4097 (27%) received a second or third-generation cephalosporin, and 4971 (33%) received Broad-abx. On multivariate analysis, Broad-abx was associated with a decrease in all-type SSI compared to 1st-3rdCE (odds ratio = 0.73–0.77, P < 0.001) after open pancreaticoduodenectomy (PD). There was no difference in SSI between antibiotic-types after distal pancreatectomy. Subgroup multivariate analysis of open PD revealed decrease in all-type SSI with Broad-abx amongst patients with jaundice and/or biliary stent only, regardless of wound protector use (odds ratio = 0.69–0.70, P < 0.001). Propensity score matching of open PD patients with jaundice and/or biliary stent confirmed a decrease in all-type SSI (19% vs 24%, P = 0.001), and organ-space SSI (12% vs 16%, P < 0.001). Conclusion: Broad-abx are associated with decreased SSI after open PD and may be preferred specifically for patients with preoperative biliary stent and/ or jaundice. [ABSTRACT FROM AUTHOR]

Porcelain gallbladder (PGB) is a gallbladder with calcium encrusted on its inner wall. PGB is rare in the pediatric population with only four cases reported in the literature. We present a patient who is the youngest reported case of porcelain gallbladder. A 4-year-old full-term male with a history of chronic constipation presented with abdominal pain prompting a plain abdominal X-ray which revealed an incidental calcified gallbladder. This was confirmed with an abdominal ultrasound (US) and computed tomography (CT) that identified calcifications in the gallbladder wall. An elective laparoscopic cholecystectomy was performed, given the reported association of PGB with gallbladder cancer. Final pathology confirmed calcification of the gallbladder, along with evidence of cholelithiasis, and cholecystitis, but no dysplasia or malignancy. The patient was discharged on post-operative day 2 without any complications. A PGB is a rare finding in the pediatric population, with prior studies indicating an association with malignancy and cholecystitis in the adult population. However, there is not enough data to support the association of PGB with future pathologies in the pediatric population and surgical intervention may not be warranted. [ABSTRACT FROM AUTHOR]

Objectives: Patients with glioblastoma (GBM) have an inherently shortened survival because of their disease. It has been recently shown that carmustine wafers in addition to other therapies (surgery, temozolomide, and radiation) can further extend survival. There is concern, however, that these therapies may increase infection risk. The goals of this study were to calculate the incidence of postoperative infection, evaluate if carmustine wafers changes the risk of infection and identify factors independently associated with an infection following GBM surgery. Methods: All patients who underwent non-biopsy, surgical resection of an intracranial GBM from 2007 to 2011 at a single institution were retrospectively reviewed. Stepwise multivariate proportional hazards regression analysis was used to identify factors associated with infection, including the use of carmustine wafers. Variables with P <0.05 were considered statistically significant. Results: Four hundred and one patients underwent resection of an intracranial GBM during the reviewed period, and 21 (5%) patients developed an infection at a median time of 40 [28-286] days following surgery. The incidence of infection was not higher in patients who had carmustine wafers, and this remained true in multivariate analyses to account for differences in treatment cohorts. The factors that remained significantly associated with an increased risk of infection were prior surgery [RR (95% CI); 2.026 (1.473- 4.428), P= 0.01], diabetes mellitus [RR (95% CI); 6.090 (1.380-9.354)], P= 0.02], and increasing duration of hospital stay [RR (95% CI); 1.048 (1.006-1.078); P= 0.02], where the greatest risk occurred with hospital stays >5 days [RR (95% CI); 3.904 (1.003-11.620), P= 0.05]. Discussion: These findings may help guide treatment regimens aimed at minimizing infection for patients with GBM. [ABSTRACT FROM AUTHOR]