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Pancreatectomy Surgical Site Infections: What Are the Risk Factors?
Gareth Morris-Stiff*2, Colin O'Rourke1, R Matthew Walsh2, Henry Pitt3
1Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH; 2HPB Surgery, Cleveland Clinic Foundation, Cleveland, OH; 3General Surgery, Temple University, Philadelphia, PA
BACKGROUND: The morbidity of pancreatectomy remains unacceptably high. Surgical site infections (SSIs) account for approximately half of this morbidity, and the SSI rate following pancreatectomy is the highest among all gastrointestinal operations. However, the risk factors for SSI following pancreatectomy have not been adequately defined. Therefore, the aim of this analysis was to attempt to identify those factors associated with SSI occurring after pancreatectomy.
METHODS: The American College of Surgeons-National Surgical Quality Improvement Program Participant Use File was queried from 2011-13. Patients undergoing proximal, distal, and total pancreatectomy as well as enucleation were included in the analysis. Multiple pre- and intraoperative parameters were analyzed as potential risk factors. SSIs were characterized as superficial, deep and organ space infections (OSIs). Multivariable logistic regression models were performed to determine the risk factors for OSI and any SSI.
RESULTS: 16,664 patients were available for analysis. The superficial, deep and OSI rates were 7.6, 2.3 and 10.7 percent, respectively, for an overall SSI rate of 20.6 percent. Any SSI rates were significantly higher for proximal resections when compared to distal ones or to other resection types (p<0.001). The SSI rates were similar for benign and malignant pathology (malignant versus benign, p= 0.13). Risk factors for both OSI and any SSI included male gender, Hispanic ethnicity, increased ASA class and BMI, Preoperative sepsis and operative time. Wound classification was an additional risk factor for superficial SSI, and smoking was an independent predictor for deep SSI.
CONCLUSIONS: This analysis documents that a) SSI rates following pancreatectomy are unacceptably high, b) SSI rates are higher for proximal than for distal pancreatectomy c) and the only modifiable factors are preoperative cholangitis and operative time. Future efforts to reduce SSIs should focus on antibiotic choice and redosing, wound protection and operative technique.
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