Predictors of surgical site infection after liver resection: a multicentre analysis using National Surgical Quality Improvement Program data.

BACKGROUND   Postoperative infections are frequent complications after liver resection and have significant impact on length of stay, morbidity and mortality. Surgical site infection (SSI) is the most common nosocomial infection in surgical patients, accounting for 38% of all such infections. OBJECTIVES   This study aimed to identify predictors of SSI and organ space SSI after liver resection. METHODS   Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for patients who underwent liver resection in 2005, 2006 or 2007 in any of 173 hospitals throughout the USA were analysed. All patients who underwent a segmental resection, left hepatectomy, right hepatectomy or trisectionectomy were included. RESULTS   The ACS-NSQIP database contained 2332 patients who underwent hepatectomy during 2005-2007. Rates of SSI varied significantly across primary procedures, ranging from 9.7% in segmental resection patients to 18.3% in trisectionectomy patients. A preoperative open wound, hypernatraemia, hypoalbuminaemia, elevated serum bilirubin, dialysis and longer operative time were independent predictors for SSI and for organ space SSI. CONCLUSIONS   These findings may contribute towards the identification of patients at risk for SSI and the development of strategies to reduce the incidence of SSI and subsequent costs after liver resection.

[1]  J. Reilly,et al.  Procedure-Specific Surgical Site Infection Rates and Postdischarge Surveillance in Scotland , 2006, Infection Control & Hospital Epidemiology.

[2]  L. Neumayer,et al.  Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. , 2007, Journal of the American College of Surgeons.

[3]  W. Henderson,et al.  Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. , 1999, Archives of surgery.

[4]  M. Zwahlen,et al.  Economic Burden of Surgical Site Infections at a European University Hospital , 2008, Infection Control & Hospital Epidemiology.

[5]  O. Jonasson,et al.  The patient safety in surgery study: background, study design, and patient populations. , 2007, Journal of the American College of Surgeons.

[6]  Yuman Fong,et al.  Improvement in Perioperative Outcome After Hepatic Resection: Analysis of 1,803 Consecutive Cases Over the Past Decade , 2002, Annals of surgery.

[7]  J. Martin-Moreno,et al.  Are we really seeing the total costs of surgical site infections? A Spanish study , 2007, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[8]  K. Hanazaki,et al.  Risk factors and predictors for surgical site infection after hepatic resection. , 2009, The Journal of hospital infection.

[9]  F. Grover,et al.  Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. , 1997, Journal of the American College of Surgeons.

[10]  R. Sawyer,et al.  Infectious Complications after Hepatic Resection , 2004, The American surgeon.

[11]  S. Fan,et al.  Improving Perioperative Outcome Expands the Role of Hepatectomy in Management of Benign and Malignant Hepatobiliary Diseases: Analysis of 1222 Consecutive Patients From a Prospective Database , 2004, Annals of surgery.

[12]  H. Yamaue,et al.  Risk factors for postoperative infectious complications after hepatectomy , 2011, Journal of hepato-biliary-pancreatic sciences.

[13]  W. Jarvis,et al.  Status of infection surveillance and control programs in the United States, 1992-1996. Association for Professionals in Infection Control and Epidemiology, Inc. , 2000, American journal of infection control.

[14]  A. Marvaso,et al.  Incidence of Surgical Site Infections in General Surgery in Italy , 2006, Infection.

[15]  P. McHugh,et al.  Obesity, Diabetes, and Smoking are Important Determinants of Resource Utilization in Liver Resection: A Multicenter Analysis of 1029 Patients , 2009, Annals of surgery.

[16]  Stephen L. Jones,et al.  Predicting poor outcome following hepatectomy: analysis of 2313 hepatectomies in the NSQIP database. , 2009, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[17]  I. Endo,et al.  Perioperative infection control and its effectiveness in hepatectomy patients , 2007, Journal of gastroenterology and hepatology.

[18]  F. Grover,et al.  The Department of Veterans Affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. , 1998, Annals of surgery.

[19]  M. Malangoni,et al.  Predictive factors for surgical site infection in general surgery. , 2008, Surgery.

[20]  T. Kinoshitá,et al.  Risk Factors of Surgical Site Infection After Hepatectomy for Liver Cancers , 2009, World Journal of Surgery.

[21]  W J Martone,et al.  Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. , 1991, The American journal of medicine.

[22]  S. Msika,et al.  Risk factors for postoperative infectious complications in noncolorectal abdominal surgery: a multivariate analysis based on a prospective multicenter study of 4718 patients. , 2003, Archives of surgery.

[23]  L. Neumayer,et al.  Surgical site infection prevention: the importance of operative duration and blood transfusion--results of the first American College of Surgeons-National Surgical Quality Improvement Program Best Practices Initiative. , 2008, Journal of the American College of Surgeons.