Systematic Review of Risk Factors Predicting Surgical Site Infection Following Pancreatic and Liver Resections

Abstract

Introduction: The risk factors for surgical site infection (SSI) after HPB surgery are poorly reported. This review aimed to identify the risk factor profile for SSI after pancreas and liver resection. Method: The PUBMED, MEDLINE, EMBASE databases were systematically searched using the PRISMA framework. The primary outcome measure was pooled SSI rates. The secondary outcome measure was risk factor profile determination for SSI. Results: Seventeen studies including 52,416 patients made the final analysis, of which 39,748 patients underwent pancreatic resection and 12,668 patients liver resection. The overall rate of SSI after pancreatic and liver resection were 25% and 10% respectively (p< 0.001). 32% of pancreaticoduodenectomies (PD) developed SSI vs 28% after distal pancreatectomy (p< 0.001). The rate of incisional SSI in the pancreatic group was 8.8% and organ space SSI 16%. Biliary resection during liver surgery was a risk factor for SSI (25% vs 16%, p=0.004). After liver resection, the incisional SSI rate was 7.6% and organ space SSI rate was 10%. Pancreas specific SSI risk factors were male sex, pre-operative biliary drainage and chemotherapy. Liver specific SSI risk factors were smoking, open resections, significant blood loss and peri-operative blood transfusion. Conclusions: The risk factors for SSI following pancreatic and liver resections are distinct from each other, with higher SSI rates after pancreatic resection. PD has increased risk of SSI compared to DP. Similarly, biliary resections during liver surgery increase the rates of SSI.