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The clinical and economic impact of surgical site infections after distal pancreatectomy

De Pastena M, Paiella S, Fontana M, Filippini C, Addari L, Giorgi A,  Canton S, Zanusso G, Azzini AM, Bassi C, Tacconelli E, Salvia R.


Background: The present study aimed to evaluate surgical site infections' clinical and economic impact after distal pancreatectomy.

Methods:  he study was a prospective, monocentric, observational study,  including all adult patients who underwent distal pancreatectomy.  According to the American Centers for Disease Control and Prevention  definition, the surgical site infection assessment was prospectively  performed by trained personnel. The Accordion Severity Grading System  was used to evaluate the clinical burden of surgical site infection. The  hospitalization's total costs were calculated using the hospital  expenditure report, excluding the intraoperative costs.

Results:   During the study period, 414 distal pancreatectomies were  performed. The overall incidence of surgical site infection was 26% (106  patients). Surgical site infections were associated with a higher body  mass index (P = .022, odds ratio 1.2), positive preoperative rectal swab  for multidrug resistant bacteria (P = .010, odds ratio 4.2), and  increased operative time (P = .037, odds ratio 1.1). Using the Accordion  Severity Grading System, surgical site infections contributed  significantly to the total clinical burden (25.5%) and prolonged  hospitalization (P < .001). Furthermore, surgical site infection  doubled the costs (12.915 vs 6.888 euros, P < .001).

Conclusion:  Surgical site infection has a high clinical burden, negatively  impacting the postoperative course. The costs and length of stay  proportionally increased with the surgical site infection severity,  doubling the hospitalization expenses.

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