Effect of antibiotic choice on the development of surgical site infections following pancreatic resection: NSQIP Study

Abstract

Surgical site infections (SSIs) are the most common cause of morbidity following pancreatic surgery. We aim to assess the adequacy of first generation cephalosporin prophylaxis in the prevention of SSIs following pancreatic resection. The American College of Surgeons - National Surgical Quality Improvement Program Participant-Use Data-File 2016 was queried to identify patients who underwent distal pancreatectomy (DP) or pancreatoduodenectomy (PD).The Antibiotic given was grouped into: 1st generation cephalosporin (Abx1) vs 2nd/3rd generation cephalosporin or broad spectrum antibiotics (Abx2). A total of 1762 (32.5%) and 3659 (67.5%) patients underwent DP and PD, respectively. The rate of SSIs for the whole cohort in groups Abx1 and Abx2 were: 126 (6.1%) and 192 (5.7%) for superficial SSIs (P = 0.55), 8 (0.4%) and 30 (0.9%) for deep SSIs (P = 0.03) and 305 (14.8%) and 468 (13.9%) organ-space SSIs (P = 0.39), respectively. The choice of antibiotic did not significantly change the rate of SSIs in patients who underwent DP (P > 0.05). However, a significant change in the rate of organ-space SSI by choice of antibiotic was noted in PD patients; 225 (18%) and 359 (14.9%), P = 0.017, for Abx1 and Abx2, respectively. The choice of antibiotic prophylaxis influences the rate of SSIs post-pancreatic surgery with lower rates of deep SSIs in both DP and PD, and a lower rate of organ space infections after PD. Limiting coverage to first generation cephalosporins would appear inadequate. Broader coverage of gram negative infections and anaerobes should be considered and is currently been evaluated in the ACS-AHPBA trial.