Risk Factors Associated with Surgical Site Infection after Hepatectomy for Liver Disease

The incidence of postoperative SSI (surgical site infection) after hepatic resection has decreased gradually with the refinement of surgical techniques and perioperative management. However, postoperative SSI still develops in a few patients after hepatic resection, leading to increased medical costs, longer hospitalization and a reduced quality of life in the postoperative course. The purpose of this study was to analyze the risk factors of SSI and to assist in predicting the occurrence of SSI after hepatic resection. A retrospective analysis of 227 patients who underwent hepatic resection without biliary reconstruction for liver disease between January 2006 and December 2012 was performed. Patients were divided into two groups according the occurrence of SSI. The association between SSI and various clinical parameters was investigated. Nineteen patients developed SSI: 9 with superficial or deep SSI and 10 with organ/space SSI. In univariate analysis, preoperative platelets, aspartate aminotransferase and alanine aminotransferase concentrations, intraoperative blood loss, perioperative transfusion, procedure of skin closure, and postoperative bile leakage differed statistically between the two groups. Patients with SSI required significantly longer hospitalization than those without SSI. In multivariate analysis, conventional skin closure and postoperative bile leakage were the significant risk factors. It is important to prevent bile leakage to reduce postoperative SSI. Moreover, subcuticular suture for skin closure would be effective in preventing incisional SSI. Continuous efforts should be made to prevent SSI and further study is needed to develop additional new strategies for preventing SSI.