Back to 2011 Program

Objective: Although the surgical site infection after pancreaticoduodenectomy (SSI) is a critical and frequent complication, its risk factors have not been fully evaluated. Determining the risk factors for SSI may provide information on reducing complications and improving the outcome of the patients who undergo pancreaticoduodenectomy. Patients and methods: A retrospective review using prospectively collected data base of 356 patients who underwent pancreaticoduodenectomy between January 2003 and April 2010 was conducted. The demographic and clinical data of each patient were reviewed. The outcome of interest was SSI which was classified into incisional or organ/space SSI according to the CDC’s NNIS definition. Multivariate analysis was performed to assess the risk factors for SSI. Bacterial appraisal was also conducted. Results: The patients comprised of 231 males (65%) and 125 females (35%) with a median age of 68 years, consisting of 179 patients (50%) with pancreatic cancer, 35 (10%) with pancreatic tumor including intraductal papillary mucinous neoplasm or neuroendocrine tumor, 75 (21%) with bile duct cancer, 38 (11%) with ampulla of Vater carcinoma, and 29 (8%) with others. Of 356 patients, 49 (14%) patients had incisional SSI and 169 (47%) had organ/space SSI. Multivariate analysis identified main pancreatic duct (MPD) size < 3 mm (OR: 3.56), concomitant colectomy (OR: 3.27), operating time > 480 min (OR: 2.32), and blood loss > 1100 ml (OR: 2.17) as significant risk factors for incisional SSI. Whereas, the presence of pancreatic fistula (OR: 6.50), semi-closed drainage system (Penrose drain with retrieval pouch) (OR: 2.81), MPD < 3 mm (OR: 2.71), operating time > 480 minutes (OR: 2.16), and body mass index (BMI) > 22.0 kg/m2 (OR: 1.87) were found to be significantly associated with organ/space SSI. Bacterial isolation revealed that gut-derived microorganisms such as Enterococcus species, Enterobacter species, and Klebsiella species were the leading bacteria at the focus of SSI. Conclusions: Pancreatic fistula was the most powerful risk factor for organ/space SSI. Except for patients’ own factors such as smaller MPD or greater BMI, efforts to reduce pancreatic fistula, application of closed drainage system, shorter and less bleeding surgery would contribute to decrease the incidence of SSI after pancreaticoduodenectomy. When SSIs once occur and antibacterial treatment is necessary, it should be conducted targeting intestinal bacteria.