Unique predictors and economic burden of superficial and deep/organ space surgical site infections following pancreatectomy.

Abstract

BACKGROUND:

Surgical site infections (SSIs) are common following pancreatectomy and associated with significant morbidity and economic burden. We sought to identify distinct predictors for superficial versus deep/organ space SSIs and their effects on surgical outcomes.

METHODS:

ACS-NSQIP targeted pancreatectomy 2014 and 2015 databases were queried. Univariate and multivariate models were developed for both types of SSI, length of stay (LOS), and readmission. Costs were estimated based on Centers for Medicare & Medicaid Services (CMS) recommendations.

RESULTS:

Of 8093 patients, there were 422 (5.2%) superficial and 1005 (12.4%) deep/organ space SSIs. On multivariate analyses, preoperative biliary stenting was predictive only for superficial SSI (OR: 2.21), while BMI of 25-29.9 (OR: 1.25) and BMI ≥30 kg/m2 (OR: 1.53), pancreatic duct size <3 mm (OR: 1.30), and intermediate (OR: 1.67) versus hard gland texture were predictors of deep/organ-space SSI. Superficial and deep/organ space SSIs were independent predictors of prolonged LOS (OR: 1.74 vs 1.80) and readmission (OR: 2.59 vs 6.57). Additional readmission costs per patient secondary to superficial SSI and deep/organ space SSI were $7661.37 and $18,409.42, respectively.

CONCLUSION:

Deep/organ space SSI contributes more profoundly to prolonged hospital stay, readmission, and additional costs, suggesting that strategies should focus on preferential prevention of deep/organ space infections.

• Authors: Ayòtúndé B Fadayomi, Gyulnara G Kasumova, Omidreza Tabatabaie, Susanna W L de Geus, Tara S Kent, Sing Chau Ng, A James Moser, Mark P Callery, Stanley W Ashley, Jennifer F Tseng
• Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association (HPB (Oxford)) Vol. 20 Issue 7 Pg. 658-668 (07 2018) ISSN: 1477-2574 [Electronic] England
• PMID: 29526467 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Topics

• Aged
• Centers for Medicare and Medicaid Services, U.S. (economics)
• Databases, Factual
• Female
• Hospital Costs
• Humans
• Length of Stay (economics)
• Male
• Medicare (economics)
• Middle Aged
• Pancreatectomy (adverse effects, economics)
• Patient Readmission (economics)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Surgical Wound Infection (economics, epidemiology, microbiology, therapy)
• Time Factors
• Treatment Outcome
• United States (epidemiology)