Wound protectors mitigate superficial surgical site infections after pancreatoduodenectomy

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Background: Potential strategies to decrease surgical site infections (SSIs) include the choice of antibiotic prophylaxis, the type of incision, and the use of wound protectors. Wound protection has been studied extensively, but randomized trials and meta-analyses remain underpowered. Thus, the objectives of this study were to examine a national database to determine which mitigation, patient and operative factors were associated with decreased SSIs after pancreatoduodenectomy. Methods: The 2016 American College of Surgeons-National Surgical Quality Improvement Program pancreatoduodenectomy database was queried. Data on recommended antibiotic prophylaxis (1 st and 2 nd generation cephalosporins), incision (midline or subcostal) and wound protector use were gathered on 3,979 patients. Multivariable logistic regression models were constructed to determine the effect of antibiotic prophylaxis, incision type, and wound protector use as well as patient and operative factors on SSIs. Results: The overall SSI rate was 19.9%. Superficial SSIs occurred in 6.9% of patients. Deep incisional SSIs developed in 0.9%, and organ space infections (OSIs) occurred in 13.9% of patients. On multivariable analyses, wound protector use was independently associated with decreased SSIs of any type (Table). This influence was mediated by a reduction in superficial SSIs but not organ space infections (OSIs). Neither antibiotic choice nor incision type influenced any category of SSI. Among multiple potential variables, being overweight or obese, contaminated/dirty wound class, soft pancreas and prolonged operative time were independently associated with OSIs. Conclusion: Wound protectors reduced superficial, but not organ space, infections in patients undergoing pancreatoduodenectomy. Wound protectors should be routinely utilized in patients undergoing pancreatoduodenectomy.TableInfluence of Mitigation, Patient and Operative Variables on Any Surgical Site Infection (SSI), Organ Space Infection and Superficial SSIVariablesFrequencyAny SSI*Organ Space Infection*Superficial SSI*MITIGATION Recommended Antibiotic63%NSNSNS Midline Incision81%NSNSNS Wound Protector17%0.73 (0.57–0.94)0.85 (0.65–1.11)0.66 (0.44–0.97)PATIENT/OPERATIVE BM (>25)70%1.54 (1.30–1.82)1.47 (1.24–1.75)NA Contaminated/Dirty17%1.96 (1.03–3.79)1.99 (1.04–3.81)NA Soft Pancreas62%1.82 (1.35–2.45)2.50 (1.40–3.50)NA Operation Time (>6 hr)22%2.09 (1.30–3.37)1.88 (1.10–3.23)NANS = Not Significant, NA = Not Associated*Adjusted Odds Ratios (95% Confidence Intervals) Open table in a new tab NS = Not Significant, NA = Not Associated *Adjusted Odds Ratios (95% Confidence Intervals)