Unique predictors and economic burden of superficial and deep/organ space surgical site infections following pancreatectomy

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d8852269e196">Background</h5> <p id="P2">Surgical site infections (SSIs) are common following pancreatectomy and associated with significant morbidity and economic burden. We sought to identify distinct predictors for the development of superficial versus deep/organ space SSIs and their effects on surgical outcomes. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d8852269e201">Methods</h5> <p id="P3">ACS-NSQIP targeted pancreatectomy 2014 and 2015 databases were queried. Univariate and multivariate models were developed for both types of SSI, length of stay (LOS), and readmission. Costs were estimated based on the Centers for Medicare &amp; Medicaid Services (CMS) recommendations. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d8852269e206">Results</h5> <p id="P4">Of 8 093 patients, there were 422 (5.2%) superficial and 1 005 (12.4%) deep/organ space SSIs. On multivariate analyses, preoperative biliary stenting was a predictor only for superficial SSI (OR: 2.21), while BMI of 25–29.9 (OR: 1.25) and BMI ≥30kg/m ² (OR: 1.53), pancreatic duct size &lt;3mm (OR: 1.30), and intermediate (OR: 1.67) versus hard gland texture were predictors of deep/organ-space SSI. Superficial and deep/organ space SSIs were independent predictors of prolonged LOS (OR 1.74 vs 1.80) and readmission (OR 2.59 vs 6.57). Additional readmission costs per patient secondary to superficial SSI and deep/organ space SSI were $7 661.37 and $18 409.42, respectively. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d8852269e214">Conclusion</h5> <p id="P5">Deep/organ space SSI contributes more profoundly to prolonged hospital stay, readmission, and additional costs, suggesting that strategies should focus on preferential prevention of deep/organ space infections. </p> </div>