Incidence, risk factors, outcomes, and prediction model of surgical site infection after hepatectomy for hepatocellular carcinoma: A multicenter cohort study.

BACKGROUND & AIMS: Surgical site infection (SSI) is a common complication after hepatectomy for hepatocellular carcinoma (HCC), but its risk factors and impact on outcomes remain poorly characterized. We aimed to investigate the incidence, risk factors, and outcomes of SSI after hepatectomy for HCC and develop a prediction model.

METHODS

This multicenter retrospective study included patients who underwent curative-intent hepatectomy for HCC across 15 Chinese hepatobiliary centers from 2010 to 2021. SSI was defined according to Centers for Disease Control and Prevention criteria. Logistic regression identified independent risk factors for SSI. A nomogram was developed and internally validated.

RESULTS

Among 4124 patients, 393 (9.5 %) developed SSI; 76 (19.3 %) were diagnosed after discharge. SSI was associated with prolonged hospital stay (mean: 21 vs. 11 days), higher 30-day readmission (13.7 % vs. 3.2 %), and 90-day mortality (5.1 % vs. 2.9 %) (all P < 0.001). Independent risk factors for SSI were obesity (odds ratio [OR] 2.12), diabetes (OR 3.31), portal hypertension (OR 1.96), blood loss ≥400 mL (OR 1.75), open approach (OR 4.99), diaphragmatic incision (OR 2.27), major hepatectomy (OR 1.88), and operative time ≥180 min (OR 1.55). The nomogram model and online calculator (http://asapcalculate.top/Cal14_en.html) demonstrated good discrimination (C-index 0.733) and calibration.

CONCLUSIONS

SSI was common after hepatectomy for HCC and associated with worse short-term postoperative outcomes. The novel easy-to-use prediction calculator may facilitate individualized risk assessment and guide targeted preventive strategies. Future studies should focus on external validation and evaluating interventions in high-risk patients.