Skip to main content

Advertisement

SpringerLink
Log in

Clinical Predictive Score for Cholecystectomy Wound Infection: WEBAC Score

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Most common surgical complications in cholecystectomy are surgical site infections (SSIs). SSIs have many factors, including patient, surgical, and disease factors. This study aims to find the factors which relate to SSIs 30 days after cholecystectomy and contribute to the scoring system to predict SSIs.

Methods and Material

The data of patients who underwent cholecystectomy from January 2015 to December 2019 were retrospectively collected from a prospectively collected infectious control registry. The SSI was defined following the CDC criteria and assessed before discharge and at a 1-month follow-up. Variables that were independently predictive of the increased SSIs were included in the risk score.

Results

The patients who underwent cholecystectomy were 949, which were divided into 28 patients who had SSIs and 921 who had no SSIs. The rate of SSIs was 3%. The factors related to SSI in cholecystectomy were age ≥ 60 years (p = 0.045), history of smoking (p = 0.004), retrieval bag use (p = 0.005), preoperative ERCP (p = 0.02), and wound class III and IV (p = 0.007). Risk assessment was using five variables (WEBAC): (1) wound classifications, (2) preoperative ERCP, (3) retrieval plastic bag use, (4) aged ≥ 60 years, and (5) history of smoking (cigarette). If patients were aged ≥ 60 years and had a history of smoking, no plastic bag use, preoperative ERCP, or wound class III or IV, these parameters would all be scored 1 each. The WEBAC score revealed the probability of SSIs in cholecystectomy wounds.

Conclusion

The WEBAC score represents a convenient and simple tool to predict the probability of SSI in the patients who underwent cholecystectomy and might increase the surgeons’ awareness of postoperative SSI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

IQR :

interquartile range

kg :

kilogram

m :

meter

RLQ :

right lower quadrant

ERCP :

endoscopic retrograde cholangiopancreatography

CI :

confidence interval

References

  1. Bray F, Balcaen T, Baro E, Gandon A, Ficheur G, Chazard E. Increased incidence of cholecystectomy related to gallbladder disease in France: Analysis of 807,307 cholecystectomy procedures over a period of seven years. J Visc Surg. 2019;156:209-15.

    Article  CAS  PubMed  Google Scholar 

  2. Sanabria A, Dominguez LC, Valdivieso E, Gomez G. Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2010;12:CD005265.

    Google Scholar 

  3. Ruangsin S, Laohawiriyakamol S, Sunpaweravong S, Mahattanobon S. The efficacy of cefazolin in reducing surgical site infection in laparoscopic cholecystectomy: a prospective randomized double-blind controlled trial. Surg Endosc. 2015;29:874-81.

    Article  PubMed  Google Scholar 

  4. Warren DK, Nickel KB, Wallace AE, Mines D, Tian F, Symons WJ et al. Risk Factors for Surgical Site Infection After Cholecystectomy. Open Forum Infect Dis. 2017;4:36.

    Article  Google Scholar 

  5. McGuckin M, Shea JA, Schwartz JS. Infection and antimicrobial use in laparoscopic cholecystectomy. Infect Control Hosp Epidemiol. 1999;20:624-6.

    Article  CAS  PubMed  Google Scholar 

  6. Bogdanic B, Bosnjak Z, Budimir A, Augustin G, Milosevic M, Plecko V et al. Surveillance of surgical site infection after cholecystectomy using the hospital in Europe link for infection control through surveillance protocol. Surg Infect (Larchmt). 2013;14:283-7.

    Article  PubMed  Google Scholar 

  7. Sippey M, Grzybowski M, Manwaring ML, Kasten KR, Chapman WH, Pofahl WE et al. Acute cholecystitis: risk factors for conversion to an open procedure. J Surg Res. 2015;199:357-61.

    Article  PubMed  Google Scholar 

  8. La Regina D, Mongelli F, Cafarotti S, Saporito A, Ceppi M, Di Giuseppe M et al. Use of retrieval bag in the prevention of wound infection in elective laparoscopic cholecystectomy: is it evidence-based? A meta-analysis BMC Surg. 2018;18:102.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Navez B, Mutter D, Russier Y, Vix M, Jamali F, Lipski D et al. Safety of laparoscopic approach for acute cholecystitis: retrospective study of 609 cases. World J Surg. 2001;25:1352-6.

    Article  CAS  PubMed  Google Scholar 

  10. Csikesz NG, Tseng JF, Shah SA. Trends in surgical management for acute cholecystitis. Surgery. 2008;144:283-9.

    Article  PubMed  Google Scholar 

  11. Zhou H, Zhang J, Wang Q, Hu Z. Meta-analysis: Antibiotic prophylaxis in elective laparoscopic cholecystectomy. Aliment Pharmacol Ther. 2009;29:1086-95.

    Article  CAS  PubMed  Google Scholar 

  12. Sørensen LT. Wound Healing and Infection in Surgery: The Clinical Impact of Smoking and Smoking Cessation: A Systematic Review and Meta-analysis. Arch Surg. 2012;147:373–83.

    Article  PubMed  Google Scholar 

  13. Overby DW, Apelgren KN, Richardson W, Fanelli R; Society of American Gastrointestinal and Endoscopic Surgeons. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc. 2010;24:2368-86.

    Article  PubMed  Google Scholar 

  14. Peponis T, Panda N, Eskesen TG, Forcione DG, Yeh DD, Saillant N et al. Preoperative endoscopic retrograde cholangio-pancreatography (ERCP) is a risk factor for surgical site infections after laparoscopic cholecystectomy. Am J Surg. 2019;218:140-4.

    Article  PubMed  Google Scholar 

  15. Rotermann M. Infection after cholecystectomy, hysterectomy, or appendectomy. Health Rep. 2004;15:11-23.

    PubMed  Google Scholar 

  16. Al-Ghnaniem R, Benjamin IS, Patel AG. Meta-analysis suggests antibiotic prophylaxis is not warranted in low-risk patients undergoing laparoscopic cholecystectomy. Br J Surg. 2003;90:365-6.

    Article  CAS  PubMed  Google Scholar 

  17. Catarci M, Mancini S, Gentileschi P, Camplone C, Sileri P, Grassi GB. Antibiotic prophylaxis in elective laparoscopic cholecystectomy. Lack of need or lack of evidence? Surg Endosc. 2004;18:638-41.

    Article  CAS  PubMed  Google Scholar 

  18. Choudhary A, Bechtold ML, Puli SR, Othman MO, Roy PK. Role of prophylactic antibiotics in laparoscopic cholecystectomy: a meta-analysis. J Gastrointest Surg. 2008;12:1847-53.

    Article  PubMed  Google Scholar 

  19. Yan RC, Shen SQ, Chen ZB, Lin FS, Riley J. The role of prophylactic antibiotics in laparoscopic cholecystectomy in preventing postoperative infection: a meta-analysis. J Laparoendosc Adv Surg Tech A. 2011;21:301-6.

    Article  PubMed  Google Scholar 

  20. Koc M, Zulfikaroglu B, Kece C, Ozalp N. A prospective randomized study of prophylactic antibiotics in elective laparoscopic cholecystectomy. Surg Endosc. 2003;17:1716-8.

    Article  CAS  PubMed  Google Scholar 

Download references

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Author information

Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

    Wongsakorn Chaochankit, Srila Samphao MD & Somrit Mahattanobon MD

  2. Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand

    Chutida Sungworawongpana MD

Authors
  1. Wongsakorn Chaochankit
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Srila Samphao MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Somrit Mahattanobon MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chutida Sungworawongpana MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

WC, SS, SM, and CS participated in study conception and design, material preparation, and data collection. WC and CS performed data analysis and prepared the first draft of the manuscript. WC, SS, SM, and CS critically reviewed the manuscript. WC revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Chutida Sungworawongpana MD.

Ethics declarations

Ethics Approval and Consent to Participate

The Ethics Committee of Research Institute, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand, approved all procedures concerning human participants (REC.63-048-10-1). This study was performed in accordance with the ethical standards of the Declaration of Helsinki (1964) and its later amendments or comparable ethical guidelines. Written informed consent was obtained from all the participants included in the study.

Consent for Publication

Not applicable.

Competing Interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chaochankit, W., Samphao, S., Mahattanobon, S. et al. Clinical Predictive Score for Cholecystectomy Wound Infection: WEBAC Score. J Gastrointest Surg 27, 1876–1882 (2023). https://doi.org/10.1007/s11605-023-05750-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-023-05750-5

Keywords

Search

Navigation