Risk factor of surgical site infection after pancreaticoduodenectomy.

BACKGROUND: Although surgical site infection (SSI) following pancreaticoduodenectomy is a common complication, the risk factors remain unclear.

PATIENTS AND METHODS: A retrospective study of 408 consecutive patients undergoing pancreaticoduodenectomy was conducted and the risk factors for SSI were assessed. The bacterial composition was also analyzed.

RESULTS: Sixty-one patients developed incisional SSI, and 195 developed organ/space SSI. A multivariate analysis identified that length of operation>480 min (odds ratio [OR] 3.22), main pancreatic duct (MPD)≤3 mm (OR 2.18), and abdominal wall thickness>10 mm (OR 2.16) were significant risk factors for incisional SSI. The development of pancreatic fistula (OR 7.56), use of semi-closed drainage system (OR 3.68), body mass index>23.5 kg/m2 (OR 3.04), MPD≤3 mm (OR 2.21), and length of operation>480 min (OR 1.78) were significantly associated with organ/space SSI. Bacterial isolation at the SSI foci revealed that gut-derived micro-organisms were the predominant bacterial species.

CONCLUSIONS: The presence of pancreatic fistula was the strongest risk factor for organ/space SSI. Efforts to reduce the development of pancreatic fistulas, to decrease length of operation, and to use a closed drainage system would decrease the incidence of SSI following pancreaticoduodenectomy. If SSI that requires antibacterial treatment occurs, then the treatment should target enterobacteria.