Prior inpatient admission increases the risk of post-operative infection in hepatobiliary and pancreatic surgery.
BACKGROUND
Hepatobiliary and pancreatic (HPB) operations have a high incidence of post-operative nosocomial infections. The aim of the present study was to determine whether hospitalization up to 1 year before HPB surgery is associated with an increased risk of post-operative infection, surgical-site infection (SSI) and infection resistant to surgical chemoprophylaxis.


METHODS
A retrospective cohort study of patients undergoing HPB surgeries between January 2008 and June 2013 was conducted. A multivariable logistic regression model was used for controlling for potential confounders to determine the association between pre-operative admission and post-operative infection.


RESULTS
Of the 1384 patients who met eligibility criteria, 127 (9.18%) experienced a post-operative infection. Pre-operative hospitalization was independently associated with an increased risk of a post-operative infection [adjusted odds ratio (aOR): 1.61, 95% confidence interval [CI]: 1.06-2.46] and SSI (aOR: 1.79, 95% CI: 1.07-2.97). Pre-operative hospitalization was also associated with an increased risk of post-operative infections resistant to standard pre-operative antibiotics (OR: 2.64, 95% CI: 1.06-6.59) and an increased risk of resistant SSIs (OR: 3.99, 95% CI: 1.25-12.73).


CONCLUSIONS
Pre-operative hospitalization is associated with an increased incidence of post-operative infections, often with organisms that are resistant to surgical chemoprophylaxis. Patients hospitalized up to 1 year before HPB surgery may benefit from extended spectrum chemoprophylaxis.
Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Zachary M
ZM
Dong
Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Alexis P
AP
Chidi
Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Julie
J
Goswami
Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Katrina
K
Han
Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Richard L
RL
Simmons
Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Matthew R
MR
Rosengart
Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Allan
A
Tsung
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008099:Liver / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010179:Pancreas / Q000601:surgery*; D010359:Patient Readmission; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents