title: Risk factors for incisional and organ space surgical site infections after liver resection are different.
abstract: BACKGROUND
  Surgical site infection (SSI) is a common cause of major morbidity after liver resection. This study aimed to identify the risk factors for incisional and organ/space SSIs after liver resection.
  
  
  METHODS
  Our liver surgery database was retrospectively analyzed for patients treated between January 2009 and November 2012 in a tertiary care Swiss hospital. Univariate and multivariate analyses were conducted on preoperative, intraoperative, and postoperative variables to identify risk factors for incisional and organ/space SSIs.
  
  
  RESULTS
  In a total of 226 patients, SSI incidences were 12.8 % (incisional), 4.0 % (organ/space), and 1.8 % (both). Univariate analysis showed that incisional SSIs were associated with high American Society of Anesthesiologists (ASA) scores, preoperative anemia, hypoalbuminemia, low prothrombin time, viral or alcoholic chronic hepatitis, liver cirrhosis, and prolonged operation times. Organ/space SSIs were associated with high rates of red blood cell transfusions, concomitant bowel surgery, and prolonged operation times. Multivariate analysis revealed that risk factors for incisional SSIs were anemia [odds ratio (OR) 2.82], high ASA scores (OR 2.88), presence of hepatitis or cirrhosis (OR 5.07), and prolonged operation times (OR 9.61). The only risk factor for organ/space SSIs was concomitant bowel surgery (OR 5.53). Hospital stays were similar in organ/space and incisional SSI groups, but significantly longer for those with both organ/space and incisional SSIs.
  
  
  CONCLUSIONS
  High ASA scores, anemia, chronic hepatitis or liver cirrhosis, and prolonged operations increased the risk of incisional SSIs; concomitant bowel surgery increased the risk of organ/space SSI. Specific precautions to prevent organ/space and incisional SSIs may shorten hospital stays.
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland, kokudo-tky@umin.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kokudo
authors.forename: Emilie
authors.initials: E
authors.lastname: Uldry
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Nermin
authors.initials: N
authors.lastname: Halkic
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000740:Anemia / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000473:pathology*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D005490:Focal Infection / Q000453:epidemiology*; D006304:Health Status; D006498:Hepatectomy / Q000009:adverse effects*; D006519:Hepatitis, Alcoholic / Q000453:epidemiology; D006525:Hepatitis, Viral, Human / Q000453:epidemiology; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology; D015994:Incidence; D059413:Intraabdominal Infections / Q000453:epidemiology*; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000453:epidemiology; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011517:Prothrombin Time; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*