title: Postoperative infectious complications after pancreatic resection.
abstract: BACKGROUND
  Although mortality associated with pancreatic surgery has decreased dramatically, high morbidity rates are still of major concern. This study aimed to identify the prevalence of, and risk factors for, infectious complications after pancreatic surgery.
  
  
  METHODS
  The Japanese Society of Pancreatic Surgery conducted a multi-institutional analysis of complications in patients who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) between January 2010 and December 2012. Risk factors that were significantly associated with infectious complications in univariable models were included in a multivariable logistic regression model, and a nomogram was created to predict the risk of infectious complications after pancreatectomy.
  
  
  RESULTS
  Infectious complications occurred in 1459 (35.2 per cent) of 4147 patients in the PD group and 426 (25.2 per cent) of 1692 patients in the DP group (P < 0.001). Nine risk factors for infectious complications after PD were identified: male sex, age 70 years or more, body mass index at least 25 kg/m(2), other previous malignancy, liver disease, bile contamination, duration of surgery 7 h or longer, intraoperative blood transfusion and soft pancreas. Five risk factors for infectious complications after DP were identified: chronic steroid use, smoking, duration of surgery 5 h or more, intraoperative blood transfusion and non-laparoscopic surgery. Occurrence of a postoperative infectious complication was significantly associated with mortality and reoperation after PD (odds ratio (OR) 4.33, 95 per cent c.i. 2.01 to 9.92 and OR 3.26, 1.86 to 5.82, respectively) and DP (OR 6.32, 1.99 to 22.55; OR 3.74, 1.61 to 9.04).
  
  
  CONCLUSIONS
  Prolonged operating time, intraoperative blood transfusion, bile contamination (PD) and non-laparoscopic surgery (DP) are risk factors for postoperative infectious complications that could be targeted to improve outcome after pancreatectomy.
authors.affiliation: Departments of Gastroenterological Surgery, Kagawa University, Kagawa, Sendai, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Okano
authors.affiliation: Departments of Public Health, Faculty of Medicine, Kagawa University, Kagawa, Sendai, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hirao
authors.affiliation: Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Unno
authors.affiliation: Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Fujii
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yoshitomi
authors.affiliation: Department of Gastroenterological Surgery, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Surgery, Kansai Medical University, Hirakata, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Satoi
authors.affiliation: Department of Hepato-Biliary Pancreatic Surgery, National Cancer Centre Hospital East, Kashiwa, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Gastroenterological Surgery, Chiba Cancer Centre, Chiba, Japan.
authors.forename: O
authors.initials: O
authors.lastname: Kainuma
authors.affiliation: Departments of Gastroenterological Surgery, Kagawa University, Kagawa, Sendai, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Suzuki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012086:Reoperation; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult