Abstract
BackgroundSurgical site infection is a major perioperative issue. The morbidity of surgical site infection is high in major digestive surgery, such as pancreaticoduodenectomy. The comprehensive risk factors, including anesthetic factors, for surgical site infection in pancreaticoduodenectomy are unknown. The aim of this study was to investigate the perioperative and anesthetic risk factors of surgical site infection in pancreaticoduodenectomy.MethodsThis was a retrospective cohort study conducted in a single tertiary care center. A total of 326 consecutive patients who underwent pancreaticoduodenectomy between January 2009 and March 2018 were evaluated. Patients who underwent resection of other organs were excluded. The primary outcome was the incidence of surgical site infection, based on a Clavien-Dindo classification of grade 2 or higher. Multivariable logistic regression analysis was performed to investigate the association between surgical site infection and perioperative and anesthetic factors.ResultsOf the 326 patients, 116 (35.6%) were women. The median age was 70 years (interquartile range; 64–75). The median duration of surgery was 10.9 hours (interquartile range; 9.5–12.4). Surgical site infection occurred in 60 patients (18.4%). The multivariable analysis revealed that the use of desflurane as a maintenance anesthetic was associated with a significantly lower risk of surgical site infection than sevoflurane (odds ratio, 0.503; 95% confidence interval [CI], 0.260–0.973). In contrast, the duration of surgery (odds ratio, 1.162; 95% CI, 1.017–1.328), cerebrovascular disease (odds ratio, 3.544; 95% CI, 1.326–9.469), and ischemic heart disease (odds ratio, 10.839; 95% CI, 1.887–62.249) were identified as significant risk factors of surgical site infection.ConclusionsDesflurane may be better than sevoflurane in preventing surgical site infection in pancreaticoduodenectomy. Cerebrovascular disease and ischemic heart disease are potential newly-identified risk factors of surgical site infection in pancreaticoduodenectomy.
Highlights
Surgical site infection refers to infection of the skin and subcutaneous tissue at the incision, organ, or space that occurs after surgery [1]
The multivariable analysis revealed that the use of desflurane as a maintenance anesthetic was associated with a significantly lower risk of surgical site infection than sevoflurane
It is reported that the incidence of surgical site infection in overall surgery is approximately 2–5% [6, 8]; in contrast, the incidence of surgical site infection in pancreaticoduodenectomy is as high as 10–30% [7, 9, 10]
Summary
Surgical site infection refers to infection of the skin and subcutaneous tissue at the incision, organ, or space that occurs after surgery [1]. Surgical site infections increase the length of hospital stay, reoperation rate, and number of in-hospital deaths, and greatly affects the postoperative outcome of patients undergoing surgery [2, 3]. It increases medical costs [2, 4, 5]. If surgical site infection occurs, mortality increases to 6%, and the hospital stay is extended by approximately 10 days [3]. The aim of this study was to investigate the perioperative and anesthetic risk factors of surgical site infection in pancreaticoduodenectomy
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