Determinants of Surgical Site Infections Following Pancreatoduodenectomy

Background: Surgical site infections (SSI) following pancreatoduodenectomy (PD) contribute to adverse perioperative and long-term outcomes. Hence, the need to determine the modifiable factors related to their causation. Aim: To identify demographic, nutritional, surgical and histopathological factors significantly associated with incisional SSIs. Methods: A retrospective analysis of a prospectively maintained database of consecutive patients who underwent PD for pancreatic and periampullary lesions at a tertiary care referral centre, between April 2010 and June 2014 was carried out. Patients were divided into two groups based on the SSIs (Group 1 - With SSI; Group 2 - No SSI). All patients were administered three, once daily doses of Ertapenem (1 g) as follows: within 1 h prior to induction, and on day 1 and day 2 following surgery. No further antibiotics were given prior to discharge unless clinically indicated. Results: 35 out of 277 patients (12.6 %) developed SSIs. No demographic (age, sex, BMI), nutritional (serum albumin), surgical (pancreatic duct size and texture, surgical duration and intraoperative blood transfusions) and histopathological factors (malignancy vs. benign) were noted between the two groups. However, SSIs were significantly higher in patients with endocrine co-morbidities (other than diabetes mellitus), in those patients who had undergone prior ERCP and stenting, as well as an end-to-side pancreaticojejunostomy. Patients with diabetes mellitus had a significantly lower incidence of wound infections (P = .014). Conclusion: Preoperative ERCP and stenting, end-to-side PJ and the presence of non-diabetic endocrine co-morbidity may result in a significantly higher risk of SSIs. Further studies targeting these patient subpopulations are warranted to enable a better understanding of how these factors contribute to the incidence of SSIs following PD.