Revista do Colégio Brasileiro de Cirurgiões
http://www.rcbc.periodikos.com.br/article/doi/10.1590/0100-6991e-2026004226
Revista do Colégio Brasileiro de Cirurgiões
Original Article

Bacteriobilia Polimicrobiana Está Associada à Mortalidade em 90 Dias Após Duodenopancreatectomia

Polymicrobial Bacteriobilia Is Associated with 90-Day Mortality After Pancreaticoduodenectomy

Philipe Franco do Amaral Tafner; Fernando Girardi da Silva; Alice Lily Carranza Cunha; Isabella Ferreira de Oliveira dos Santos; Martinho Antonio Gestic; Murillo Pimentel Utrini; Francisco Callejas-Neto; Everton Cazzo

http://dx.doi.org/10.1590/0100-6991e-2026004226 RCBC, vol.53, e2026004226, 2026
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Resumo

Introdução: A bacteriobilia é comum em pacientes submetidos à duodenopancreatectomia (DP), especialmente após drenagem biliar pré-operatória. Seu impacto sobre os desfechos perioperatórios e a mortalidade precoce estendida permanece controverso. Este estudo avaliou a associação entre culturas de bile obtidas no intraoperatório e os desfechos pós-operatórios precoces após DP por tumores periampulares.

Métodos: Este estudo de coorte retrospectivo incluiu 176 pacientes submetidos à DP com coleta de cultura de bile no intraoperatório entre 2013 e 2024, em um centro terciário. Os pacientes foram estratificados de acordo com a presença de bacteriobilia. Foram analisadas variáveis perioperatórias, complicações pós-operatórias (classificação de Clavien-Dindo) e mortalidade em 30, 60 e 90 dias. Modelos de regressão logística multivariada foram utilizados para identificar preditores independentes de bacteriobilia e de mortalidade precoce.

Resultados: Bacteriobilia foi identificada em 146 pacientes (83%), dos quais 70% apresentaram culturas polimicrobianas. A colangiopancreatografia retrógrada endoscópica (CPRE) pré-operatória (OR 23,48; IC95% 6,47-85,22; p<0,001) e a colocação de prótese biliar (OR 8,78; IC95% 1,98-38,86; p=0,004) foram preditores independentes de bacteriobilia. A mortalidade global foi de 12,5% em 30 dias, 16,0% em 60 dias e 16,5% em 90 dias. A bacteriobilia, isoladamente, não esteve associada ao aumento da morbidade maior ou da mortalidade. Entretanto, culturas de bile polimicrobianas foram independentemente associadas à maior mortalidade em 60 dias (OR 2,32; IC95% 1,35-3,88; p=0,004) e em 90 dias (OR 20,07; IC95% 1,32-304,81; p=0,031), após ajuste para ressecção vascular, sangramento, transfusão e complicações graves.

Conclusões: Embora a bacteriobilia seja altamente prevalente após drenagem biliar pré-operatória, ela não piora de forma independente os desfechos perioperatórios. Em contrapartida, culturas de bile polimicrobianas estiveram associadas ao aumento da mortalidade em 60 e 90 dias, podendo identificar um subgrupo de pacientes com maior complexidade biológica e perioperatória, ressaltando a importância da estratificação microbiológica e da avaliação da mortalidade estendida após a duodenopancreatectomia.

Palavras-chave

Duodenopancreatectomia; Bacteriobilia; Infecções das Vias Biliares; Colangiopancreatografia Retrógrada Endoscópica; Complicações Pós-Operatórias

Abstract

Introduction: Bacteriobilia is common in patients undergoing pancreaticoduodenectomy (PD), particularly after preoperative biliary drainage. Its impact on perioperative outcomes and extended early mortality remains controversial. This study evaluated the association between intraoperative bile cultures and early postoperative outcomes following PD for periampullary tumors.

Methods: This retrospective cohort study included 176 patients who underwent PD with intraoperative bile culture between 2013 and 2024 at a tertiary center. Patients were stratified according to bacteriobilia status. Perioperative variables, postoperative complications (Clavien-Dindo classification), and mortality at 30, 60, and 90 days were analyzed. Multivariable logistic regression identified independent predictors of bacteriobilia and early mortality.

Results: Bacteriobilia was detected in 146 patients (83%), with 70% presenting polymicrobial cultures. Preoperative ERCP (OR 23.48; 95% CI 6.47-85.22; p<0.001) and biliary stent placement (OR 8.78; 95% CI 1.98-38.86; p=0.004) independently predicted bacteriobilia. Overall mortality was 12.5% at 30 days, 16.0% at 60 days, and 16.5% at 90 days. Bacteriobilia per se was not associated with increased major morbidity or mortality. However, polymicrobial bile cultures were independently associated with higher mortality at 60 (OR 2.32; 95% CI 1.35-3.88; p=0.004) and 90 days (OR 20.07; 95% CI 1.32-304.81; p=0.031), after adjustment for vascular resection, bleeding, transfusion, and severe complications.

Conclusions: Although bacteriobilia is highly prevalent after preoperative biliary drainage, it does not independently worsen perioperative outcomes. Polymicrobial bile cultures were associated with increased 60- and 90-day mortality and may identify a subgroup of patients with greater biological and perioperative complexity, highlighting the importance of microbiological stratification and extended mortality assessment after PD.

Keywords

Pancreaticoduodenectomy; Bacteriobilia; Biliary Tract Infections; Cholangiopancreatography, Endoscopic Retrograde; Postoperative Complications

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Submitted date:
04/09/2026

Accepted date:
06/25/2026

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