Postoperative infectious complications after pancreatic resection

Abstract

Background Although 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. Methods The 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. Results Infectious complications occurred in 1459 (35·2 per cent) of 4147 patients in the PD group and 426 (25·2 per cent) of 1692 patients in the DP group (P < 0·001). Nine risk factors for infectious complications after PD were identified: male sex, age 70 years or more, body mass index at least 25 kg/m2, other previous malignancy, liver disease, bile contamination, duration of surgery 7 h 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 5 h 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) 4·33, 95 per cent c.i. 2·01 to 9·92 and OR 3·26, 1·86 to 5·82, respectively) and DP (OR 6·32, 1·99 to 22·55; OR 3·74, 1·61 to 9·04). Conclusion Prolonged 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.