Biliary Tract Microflora in Patients Undergoing Cholecystectomy for Acute Biliary Tract Disease: An Analysis of the Effect of Bile Spillage and Microbiology on Outcomes
Bibliographic record
Abstract
Introduction Bile spillage (BS) is common during laparoscopic cholecystectomy (LC) and has been shown to be associated with an increased risk of surgical site infection (SSI). We hypothesized that positive bile cultures (PBCs) increase the risk of postoperative complication including SSI. Methods A retrospective chart review was conducted including all patients older than 18 years undergoing urgent LC from January to September 2019. Charts were reviewed for the index admission and postoperative visits. We compared those who had PBCs with those who did not. Our primary endpoint was the rate of SSI. Univariate analysis and multivariate logistic regression were used to identify predictors of SSI. Results 272 patients underwent LC. Indications for operation included acute cholecystitis (62.5%), symptomatic cholelithiasis (12.5%), and other indications (25%). Bile was spilled in 191 patients (70.2%). Positive bile cultures were obtained in 78 of 249 (31.3%) patients and were associated with preoperative endoscopic retrograde cholangiopancreatography (ERCP; 44% vs 26%, P = 0.014) and drain placement (50% vs 28.9%, P = 0.031). Eleven postoperative complications were noted, including 6 SSI (2.2%). Positive bile culture (3.8% vs 1.8%, P = 0.38), BS (3.1% vs 0%, P = 0.18), ERCP (1.4% vs 2.5%, P = 1.0), and drain placement (6.7% vs 1.7%, P = 0.13) were not associated with SSI. Multivariate analysis demonstrated that positive cultures were not predictive of complication ( P = 0.13) or SSI ( P = 0.91). Conclusion Positive bile cultures are not inherently associated with an increased risk of SSI and therefore should not lead to ongoing postoperative antibiotic therapy.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".