A novel, validated risk score to predict surgical site infection after pancreaticoduodenectomy.
Although pancreaticoduodenectomy (PD) outcomes have improved, complications including surgical site infection (SSI) remain common. We present a stratification tool to predict risk for SSI after PD.



Data was retrospectively reviewed on all patients undergoing PD at a tertiary hospital (9/2011-8/2014). Potential SSI risk factors identified by univariate analysis were incorporated into a multivariate logistic regression model. The resulting odds ratios were converted into a point system to create an SSI risk score with internal validation.



Six hundred seventy nine patients underwent PD and were chronologically split into derivation (443 patients) and validation (236 patients) groups. There was no difference in demographics or perioperative outcomes between groups. Overall thirty-day SSI was observed in 17.2% (n = 117). Neoadjuvant chemotherapy and/or radiation, intraoperative red blood cell transfusion, operative time greater than 7 h, preoperative bile stent/drain, and vascular resection were associated with SSI in univariate analysis (all p < 0.05). On multivariate analysis, preoperative bile stent/drain and neoadjuvant chemotherapy were independent predictors of SSI, each assigned 1 point (both p < 0.001). Patients with 0, 1, and 2 points, respectively, had 0%, 32%, and 64% predicted risk of SSI (AUC = 0.73, R2= 0.93). The model performed equivalently in the validation group (AUC = 0.77, R2= 0.99).



This novel, validated risk score accurately predicts SSI risk after pancreaticoduodenectomy. Identifying the highest risk patients can help target interventions to reduce SSI.
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Katherine E
KE
Poruk
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Joseph A
JA
Lin
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Michol A
MA
Cooper
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Jin
J
He
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Martin A
MA
Makary
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Kenzo
K
Hirose
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
John L
JL
Cameron
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Timothy M
TM
Pawlik
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Christopher L
CL
Wolfgang
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Frederic
F
Eckhauser
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA. Electronic address: mweiss5@jhmi.edu.
Matthew J
MJ
Weiss
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003661:Decision Support Techniques; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D054843:Negative-Pressure Wound Therapy; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology* / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult