Elliott IA, et al. - This study was initiated in order to stratify superficial and organ-space surgical site infection (SSI) after pancreatectomy. Additionally, the authors explored their modifiable risk factors. An increase was brought in the superficial SSI due to the use of preoperative biliary stenting and corticosteroid, even in patients receiving perioperative piperacillin-tazobactam. The findings suggested that additional measures, including extended broad-spectrum perioperative antibiotic treatment, ought to be taken into account in such patients. It was noted that organ/space SSIs possibly associated with pancreatic fistulae, which were not modifiable. Reporting such varied subtypes as a single, overall rate could prove to be misleading.

Methods

• This study enrolled 201 patients undergoing pancreatic surgery at a university-based tertiary referral center from July 1, 2013, through June 30, 2015, and 10,371 patients from National Surgical Quality Improvement Program-Hepatopancreaticobiliary (NSQIP-HPB) Collaborative sites from January 1, 2014, through December 31, 2015.
• The main outcome included superficial, deep-incisional, and organ-space SSIs, as defined by NSQIP.

Results

• Among the 201 patients treated at the single center (108 men [53.7%] and 93 women [46.3%]; median age, 48.6 years [IQR, 41.4-57.3 years]), 58 presented with any SSI (28.9%); 28 (13.9%), superficial SSI; 8 (4%), deep-incisional SSI; and 24 (11.9%), organ-space SSI.
• Preoperative biliary stenting (odds ratio [OR], 4.81; 95% CI, 1.25-18.56; P=.02) and use of immunosuppressive corticosteroids (OR, 13.42; 95% CI, 1.64-109.72; P=.02) were discovered to be the independent risk factors for superficial SSI.
• In contrast, soft gland texture served as the only risk factor for organ-space SSI (OR, 4.45; 95% CI, 1.35-14.66; P=.01).
• Maximum patients with organ-space infections also reported grades B/C fistulae (15 of 24 [62.5%] vs 4 of 143 [2.8%] in patients with no SSI; P < .001).
• Organ/space but not superficial SSI correlated with an increased rate of sepsis (7 of 24 [29.2%] vs 4 of 143 [2.8%]; P < .001) and prolonged length of hospital stay (12 vs 8 days; P=.04).
• It was reported that among patients in the NSQIP-HPB Collaborative, 2,057 (19.8%) displayed any SSI; 719 (6.9%), superficial SSI; 207 (2%), deep-incisional SSI; and 1,287 (12.4%), organ-space SSI.
• Researchers affirmed that preoperative biliary stenting was an independent risk factor for superficial SSI (OR, 2.07; 95% CI, 1.58-2.71; P < .001).
• Soft gland texture was disclosed to be an independent risk factor for superficial SSI (OR, 1.45; 95% CI, 1.14-1.85; P=.002).
• However, it appeared to be more strongly and prominently related to an organ-space SSI (OR, 2.32; 95% CI, 1.88-2.85; P < .001).