Risk factor of surgical site infection after pancreaticoduodenectomy.
BACKGROUND
Although surgical site infection (SSI) following pancreaticoduodenectomy is a common complication, the risk factors remain unclear.


METHODS
A retrospective study of 408 consecutive patients undergoing pancreaticoduodenectomy was conducted and the risk factors for SSI were assessed. The bacterial composition was also analyzed.


RESULTS
Sixty-one patients developed incisional SSI, and 195 developed organ/space SSI. A multivariate analysis identified that length of operation>480 min (odds ratio [OR] 3.22), main pancreatic duct (MPD)≤3 mm (OR 2.18), and abdominal wall thickness>10 mm (OR 2.16) were significant risk factors for incisional SSI. The development of pancreatic fistula (OR 7.56), use of semi-closed drainage system (OR 3.68), body mass index>23.5 kg/m2 (OR 3.04), MPD≤3 mm (OR 2.21), and length of operation>480 min (OR 1.78) were significantly associated with organ/space SSI. Bacterial isolation at the SSI foci revealed that gut-derived micro-organisms were the predominant bacterial species.


CONCLUSIONS
The presence of pancreatic fistula was the strongest risk factor for organ/space SSI. Efforts to reduce the development of pancreatic fistulas, to decrease length of operation, and to use a closed drainage system would decrease the incidence of SSI following pancreaticoduodenectomy. If SSI that requires antibacterial treatment occurs, then the treatment should target enterobacteria.
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan. t.sugiura@scchr.jp
Teiichi
T
Sugiura
Katsuhiko
K
Uesaka
Norio
N
Ohmagari
Hideyuki
H
Kanemoto
Takashi
T
Mizuno
D000368:Aged; D015331:Cohort Studies; D004754:Enterobacter / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000175:diagnosis / Q000209:etiology*; D016983:Enterococcus / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010185:Pancreatic Fistula / Q000209:etiology; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013290:Streptococcal Infections / Q000175:diagnosis / Q000209:etiology*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology*