title: Determinants of Surgical Site Infections Following Pancreatoduodenectomy.
abstract: BACKGROUND
  Surgical site infections (SSI) following pancreatoduodenectomy (PD) contribute to adverse perioperative and long-term outcomes. Hence, the need to determine the modifiable factors related to their causation.
  
  
  OBJECTIVE
  To identify demographic, nutritional, surgical and histopathological factors significantly associated with incisional SSIs.
  
  
  METHODS
  A retrospective analysis of a prospectively maintained database of consecutive patients who underwent PD for pancreatic and periampullary lesions at a tertiary care referral centre, between April 2010 and June 2014 was carried out. Patients were divided into two groups based on the SSIs (Group 1-With SSI; Group 2-No SSI). All patients were administered three, once daily doses of Ertapenem (1 g) as follows: within 1 h prior to induction, and on day 1 and day 2 following surgery. No further antibiotics were given prior to discharge unless clinically indicated.
  
  
  RESULTS
  35 out of 277 patients (12.6 %) developed SSIs. No demographic (age, sex, BMI), nutritional (serum albumin), surgical (pancreatic duct size and texture, surgical duration and intraoperative blood transfusions) and histopathological factors (malignancy vs. benign) were noted between the two groups. However, SSIs were significantly higher in patients with endocrine co-morbidities (other than diabetes mellitus), in those patients who had undergone prior ERCP and stenting, as well as an end-to-side pancreaticojejunostomy. Patients with diabetes mellitus had a significantly lower incidence of wound infections (P = .014).
  
  
  CONCLUSIONS
  Preoperative ERCP and stenting, end-to-side PJ and the presence of non-diabetic endocrine co-morbidity may result in a significantly higher risk of SSIs. Further studies targeting these patient subpopulations are warranted to enable a better understanding of how these factors contribute to the incidence of SSIs following PD.
authors.affiliation: Department of Gastrointestinal Surgery, Gastrointestinal Oncology, and Bariatric Surgery, Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta, The Medicity, Sector 38, Gurgaon, Haryana, India, georgebarreto@yahoo.com.
authors.forename: Savio George
authors.initials: SG
authors.lastname: Barreto
authors.forename: Manish Kumar
authors.initials: MK
authors.lastname: Singh
authors.forename: Sunil
authors.initials: S
authors.lastname: Sharma
authors.forename: Adarsh
authors.initials: A
authors.lastname: Chaudhary
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004700:Endocrine System Diseases / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy; D065840:Protective Factors; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology