Meta‐Analysis and Meta‐Regression of Risk Factors for Surgical Site Infections in Hepatic and Pancreatic Resection

Abstract

Background The risk factors for surgical site infection (SSI) after HPB surgery are poorly defined. This meta‐analysis aimed to quantify the SSI rates and risk factors for SSI after pancreas and liver resection. Methods The PUBMED, MEDLINE and 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 The overall rate of SSI after pancreatic and liver resection was 25.1 and 10.4%, respectively (p < 0.001). 32% of pancreaticoduodenectomies developed SSI vs 23% after distal pancreatectomy (p < 0.001). The rate of incisional SSI in the pancreatic group was 9% and organ/space SSI 16.5%. Biliary resection during liver surgery was a risk factor for SSI (25.0 vs 15.7%, p = 0.002). After liver resection, the incisional SSI rate was 7.6% and the organ space SSI rate was 10.2%. Pancreas‐specific SSI risk factors were pre‐operative biliary drainage (p < 0.001), chemotherapy (p < 0.001) and radiotherapy (p = 0.007). Liver‐specific SSI risk factors were smoking (p = 0.046), low albumin (p < 0.001) and significant blood loss (p < 0.001). The rate of organ/space SSI in patients with POPF was 47.7% and in patients without POPF 7.3% (p < 0.001). Organ/space SSI rate was 43% in patients with bile leak and 10% in those without (p < 0.001). Conclusions The risk factors for SSI following pancreatic and liver resections are distinct from each other, with higher SSI rates after pancreatic resection. Pancreaticoduodenectomy has increased risk of SSI compared to distal pancreatectomy. Similarly, biliary resections during liver surgery increase the rates of SSI.

Worldwide incidence of surgical site infections in general surgical patients: A systematic review and meta-analysis of 488,594 patients

“…In our analyses, the cumulative incidence rate of SSI differed across procedures and surgical sites with hepatobiliary procedures having the highest incidence at 19%. Mentor et al's recent meta-analysis of 21 studies with 52,407 patients estimated the overall SSI rate for hepatobiliary surgery to be 21% (104). This result is similar to our estimate across hepatobiliary procedures.…”

The role of preoperative albumin and white blood cell count in surgical site infections following whipple surgery

“…In patients undergoing surgeries for pancreatic cancer in specific, evidence points out to the increased morbidity from all causes due to overall malnutrition and hypoalbuminemia 42 , 43 . A meta-analysis examining the risk factors for SSIs after pancreatic surgery did not show a significant role of albumin in SSI 44 . The findings in this study are limited by the fact that S/D and organ-space SSIs were combined into one outcome of interest.…”

Perioperative risk factors for delayed gastric emptying after pancreaticoduodenectomy: a meta-analysis of the complications

“…The occurrence of DGE in patients after pancreaticoduodenectomy is considered to be related to the operation time, estimated intraoperative blood loss (EIBL), pancreatic texture, preoperative biliary drainage, the American Society of Anesthesiologists (ASA) score, preoperative body mass index (BMI), postoperative pancreatic fistula, preoperative and postoperative hemoglobin, preoperative albumin level, etc. [11][12][13][14][15] Recognizing that individual studies are limited by insufficient sample size in medical institutions and may not provide sufficient data to guide practice, we sought to objectively assess whether the perioperative period factors impact the incidence of nutrition-related complications represented by DGE. Therefore, we conducted a systematic review and meta-analysis of published retrospective reviews, randomized controlled trial (RCT) studies, and systematic reviews in the past to identify risk factors for DGE during the perioperative period and attempted to present treatment methods and opinions.…”