Risk factor of surgical site infection after pancreaticoduodenectomy

World J Surg. 2012 Dec;36(12):2888-94. doi: 10.1007/s00268-012-1742-6.


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.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Cohort Studies
  • Enterobacter / isolation & purification*
  • Enterobacteriaceae Infections / diagnosis
  • Enterobacteriaceae Infections / etiology*
  • Enterococcus / isolation & purification
  • Female
  • Gram-Positive Bacterial Infections / diagnosis
  • Gram-Positive Bacterial Infections / etiology*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pancreatic Fistula / etiology
  • Pancreaticoduodenectomy*
  • Postoperative Complications
  • Retrospective Studies
  • Risk Factors
  • Streptococcal Infections / diagnosis
  • Streptococcal Infections / etiology*
  • Surgical Wound Infection / diagnosis
  • Surgical Wound Infection / etiology*