title: The impact of recent hospitalization on surgical site infection after a pancreatectomy.
abstract: BACKGROUND
  Surgical site infections (SSI) are a major cause of increased morbidity and cost after a pancreatectomy. Patients undergoing a pancreatectomy frequently have had recent inpatient hospital admissions prior to their surgical admission (recent pre-surgical admission, RPSA), which could increase the risk of SSI.
  
  
  METHODS
  The 2009-2011 Healthcare Cost Utilization Project California State Inpatient Database was used. Chi-square tests, Student's t-tests and multivariable logistic regression were used.
  
  
  RESULTS
  Three thousand three hundred and seventy-six patients underwent a pancreatectomy, and 444 (13.2%) had RPSA. One hundred and eighty (40.5%) RPSAs were to different hospitals other than where patients' pancreatectomy took place. In univariate analysis, patients with RPSA had a significantly higher rate of post-operative SSIs, and this was associated with a longer length of post-operative stay, higher post-operative hospital costs and increased postoperative 30-day readmission rates (Table 1). In Multivariate analysis, RPSA was an independent predictor of post-operative SSI [odds ratio (OR) = 1.68, P = 0.013], and the risk of SSI increased with increasing RPSA length of stay (OR = 1.07 per day, P = 0.001).
  
  
  CONCLUSIONS
  Recent pre-surgical admission is an important risk factor for SSI after a pancreatectomy. Many patients with RPSA are not admitted pre-operatively to the same hospital where the pancreatectomy occurs; in such circumstances, SSI rates may not be a sole reflection of the care provided by operating hospitals.
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Dominic E
authors.initials: DE
authors.lastname: Sanford
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO, USA.|Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO, USA.|Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO, USA.|Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
mesh_terms: D002140:California / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000639:trends*; D006760:Hospitalization / Q000191:economics / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010180:Pancreatectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors