Postoperative infectious complications after pancreatic resection

BackgroundAlthough mortality associated with pancreatic surgery has decreased dramatically, high morbidity rates are still of major concern. This study aimed to identify the prevalence of, and risk factors for, infectious complications after pancreatic surgery. MethodsThe Japanese Society of Pancreatic Surgery conducted a multi-institutional analysis of complications in patients who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) between January 2010 and December 2012. Risk factors that were significantly associated with infectious complications in univariable models were included in a multivariable logistic regression model, and a nomogram was created to predict the risk of infectious complications after pancreatectomy. ResultsInfectious complications occurred in 1459 (352 per cent) of 4147 patients in the PD group and 426 (252 per cent) of 1692 patients in the DP group (P<0001). Nine risk factors for infectious complications after PD were identified: male sex, age 70years or more, body mass index at least 25kg/m(2), other previous malignancy, liver disease, bile contamination, duration of surgery 7h or longer, intraoperative blood transfusion and soft pancreas. Five risk factors for infectious complications after DP were identified: chronic steroid use, smoking, duration of surgery 5h or more, intraoperative blood transfusion and non-laparoscopic surgery. Occurrence of a postoperative infectious complication was significantly associated with mortality and reoperation after PD (odds ratio (OR) 433, 95 per cent c.i. 201 to 992 and OR 326, 186 to 582, respectively) and DP (OR 632, 199 to 2255; OR 374, 161 to 904). ConclusionProlonged operating time, intraoperative blood transfusion, bile contamination (PD) and non-laparoscopic surgery (DP) are risk factors for postoperative infectious complications that could be targeted to improve outcome after pancreatectomy. Risk factors identified