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Proposal for a sub-classification of hepato-biliary-pancreatic operations for surgical site infection surveillance following assessment of results of prospective multicenter data

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Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background

Surgical site infection (SSI) surveillance in Japan is based on the National Nosocomial Infection Surveillance system, which categorizes all hepato-biliary-pancreatic surgeries, except for cholecystectomy, into “BILI.” We evaluated differences among BILI procedures to determine the optimal subdivision for SSI surveillance.

Methods

We conducted multicenter SSI surveillance at 20 hospitals. BILI was subdivided into choledochectomy, pancreatoduodenectomy, hepatectomy, hepatectomy with biliary reconstruction, pancreatoduodenectomy with hepatectomy, distal pancreatectomy and total pancreatectomy to determine the optimal subdivision. The outcome of interest was SSI. Univariate and multivariate analyses were performed to determine the predictive significance of variables in each type of surgery.

Results

1,926 BILI cases were included in this study. SSI rates were 23.2 % for all BILI; for choledochectomy 23.6 %, pancreatoduodenectomy 39.3 %, hepatectomy 12.8 %, hepatectomy with biliary reconstruction 41.9 %, pancreatoduodenectomy with hepatectomy 27.3 %, distal pancreatectomy 31.8 %, and total pancreatectomy 20.0 %. SSI rates for hepatectomy were significantly lower than those for non-hepatectomy BILI. Risk factors for developing SSI with hepatectomy were drain placement and long operative duration, while for non-hepatectomy BILI, risk factors were use of intra-abdominal silk sutures, SSI risk index and long operative duration.

Conclusions

Hepatectomy and non-hepatectomy BILI differ with regard to the incidence of and risk factors for developing SSI. These surgeries should be assessed separately when conducting SSI surveillance.

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Acknowledgments

The authors wish to acknowledge the nurses and physicians who cooperated in this project. Special thanks to Ikeda Municipal Hospital, NTT West Osaka Hospital, Osaka Senin Hoken Hospital, Osaka Medical Center for Cancer and Cardiovascular Diseases, Kanou Hospital, Kansai Rosai Hospital, Nara Hospital Kinki University Faculty of Medicine, Kinki Central Hospital Aid Association of Public School Teachers, Kobe Ekisaikai Hospital, National Hospital Organization, Osaka National Hospital, Shitennoji Hospital, Ikeda Municipal Hospital, Itami City Hospital, Kawanishi City Hospital, Sakai Municipal Hospital, Toyonaka Municipal Hospital, Suita Municipal Hospital, Higashiosaka City General Hospital, Fujimoto Hospital, Minoh City Hospital, and Yao Municipal Hospital.

Conflict of interest

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Authors and Affiliations

  1. Multicenter Clinical Study Group of Osaka, Risk Management Group, Osaka, Japan

    Shin Nakahira, Junzo Shimizu, Atsushi Miyamoto, Shogo Kobayashi, Koji Umeshita, Toshinori Ito, Morito Monden, Yuichiro Doki & Masaki Mori

  2. Department of Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan

    Shin Nakahira

  3. Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan

    Junzo Shimizu

  4. Department of Surgery, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan

    Atsushi Miyamoto

  5. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, E2, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Shogo Kobayashi, Koji Umeshita, Toshinori Ito, Morito Monden, Yuichiro Doki & Masaki Mori

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  1. Shin Nakahira
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  2. Junzo Shimizu
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  6. Toshinori Ito
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  8. Yuichiro Doki
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  9. Masaki Mori
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Correspondence to Shin Nakahira.

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Nakahira, S., Shimizu, J., Miyamoto, A. et al. Proposal for a sub-classification of hepato-biliary-pancreatic operations for surgical site infection surveillance following assessment of results of prospective multicenter data. J Hepatobiliary Pancreat Sci 20, 504–511 (2013). https://doi.org/10.1007/s00534-012-0590-y

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  • DOI: https://doi.org/10.1007/s00534-012-0590-y

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