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Background: Because mortality rates for pancreatic resection have fallen, other valid measures of surgical quality are needed. While infection control is a critical surrogate quality indicator, it remains incompletely understood, especially in high-acuity GI surgery. We therefore evaluated the incidence and impact of infections after our elective pancreatic resections.Methods: All pancreatic resections followed standardized perioperative care, including timely administration of antibiotics. Infections were classified according to NSQIP definitions, while complication severity was based on Clavien criteria. Clinical and economic outcomes were evaluated and predictors of infection were identified by regression analysis.Results: Of 550 pancreatic resections (356 Whipple, 167 Distal, 11 Total, 16 Other), 288 (53%) had some complication, of which 167 (31%) were infectious. Rates of infection differed by procedure (Whipple 34%, Distal 25%, Total 9%; p=0.029) but did not differ whether performed for malignancy or not. While most infections were of minor severity (n=105, Clavien 1-2), major infections (n=62, Clavien 3-5) did occur in 11% of all resections. Patients with infection did significantly worse, with longer LOS and OR time, more transfusions and ICU use, and greater EBL. They required either rehabilitation or home care 2/3rd of the time (vs 1/3rd for the non-infected) and were readmitted more often (34% vs 12%). The most common organisms were Staphylococcus, Enterococcus and E. coli. By category, wound infection (14% of all cases) was most common, followed by infected fistula (9%), UTI (7%), pneumonia (6%) and sepsis (2%). C. difficile colitis (1.6%) and line infections (0.4%) were infrequent. 48/72 clinically relevant fistulae involved polymicrobial infection and occurred equivalently for Whipple and distal fistulae. TPN use (Odds Ratio 7.3), coronary artery disease (OR 2.1), and perioperative hypotension (OR 1.6) were predictive of any infection, but specific categories of infection had different predictors. Total costs were $15,000 higher for infection cases and increased grade-for-grade across the Clavien scale, with infection accounting for 50% of the cost differential.Conclusion: Nearly one-third of our patients undergoing pancreatic resections experienced infections. Depending on severity, clinical outcomes suffered and costs rose significantly. These data are guiding process evaluations and initiatives for infection control in our unit.

	All resections	No complication	Clavien 1	Clavien 2	Clavien 3	Clavien 4	Clavien 5 (death)	p
% of Complications that were infectious	58.0	N/A	56.7	41.8	65.2	80.6	37.5	0.001
Total costNon-infected Cases	\,197	\,082	\,831	\,406	\,085	\,763	\,082
Total costInfectedCases	\,533	N/A	\,599	\,094	\,224	\,253	\,755	<0.0001