Incidence, risk factors, outcomes, and prediction model of surgical site infection after hepatectomy for hepatocellular carcinoma: A multicenter cohort study

Yang Shen; Yi-Lin Hu; Jia-Hao Xu; Shuo Zhu; Lei Cai; Yi-Fan Wu; Xiao-Chang Wu; Yong-Yi Zeng; Wei-Min Gu; Ya-Hao Zhou; Ying-Jian Liang; Hong Wang; Ting-Hao Chen; Da-Qun Liu; Yao-Ming Zhang; Xian-Ming Wang; Ming-Da Wang; Han Wu; Chao Li; Yong-Kang Diao; Li-Hui Gu; Lan-Qing Yao; Alfred Wei Chieh Kow; Timothy M Pawlik; Fei Wu; Xiao-Lei Wang; Feng Shen; Tian Yang

doi:10.1016/j.ejso.2024.109486

Incidence, risk factors, outcomes, and prediction model of surgical site infection after hepatectomy for hepatocellular carcinoma: A multicenter cohort study

Eur J Surg Oncol. 2024 Nov 22;51(2):109486. doi: 10.1016/j.ejso.2024.109486. Online ahead of print.

Authors

Yang Shen¹, Yi-Lin Hu², Jia-Hao Xu³, Shuo Zhu¹, Lei Cai⁴, Yi-Fan Wu⁵, Xiao-Chang Wu⁶, Yong-Yi Zeng⁷, Wei-Min Gu⁸, Ya-Hao Zhou⁹, Ying-Jian Liang¹⁰, Hong Wang¹¹, Ting-Hao Chen¹², Da-Qun Liu¹³, Yao-Ming Zhang¹⁴, Xian-Ming Wang¹⁵, Ming-Da Wang³, Han Wu³, Chao Li³, Yong-Kang Diao³, Li-Hui Gu³, Lan-Qing Yao³, Alfred Wei Chieh Kow¹⁶, Timothy M Pawlik¹⁷, Fei Wu¹⁸, Xiao-Lei Wang¹⁸, Feng Shen³, Tian Yang¹⁹

Affiliations

¹ Department of General Surgery, The First Affiliated Hospital, Henan University, Kaifeng, China; Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
² Department of General Surgery, General Hospital of Central Theater Command, Wuhan, China.
³ Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
⁴ Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing, China.
⁵ Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong, China.
⁶ Department of Hepatobiliary Surgery, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, China.
⁷ Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fuzhou, China.
⁸ The First Department of General Surgery, The Fourth Hospital of Harbin, Harbin, China.
⁹ Department of Hepatobiliary Surgery, Pu'er People's Hospital, Pu'er, China.
¹⁰ Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China.
¹¹ Department of General Surgery, Liuyang People's Hospital, Liuyang, China.
¹² Department of General Surgery, Ziyang First People's Hospital, Ziyang, China.
¹³ Department of Hepatobiliary and Pancreatic Surgery, General Surgery Centre, First Hospital of Jilin University, Changchun, China.
¹⁴ The 2nd Department of Hepatobiliary Surgery, Meizhou People's Hospital, Meizhou, China.
¹⁵ Department of General Surgery, First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
¹⁶ Division of Hepatopancreaticobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore.
¹⁷ Department of Surgery, Ohio State University, Wexner Medical Center, Columbus, OH, United States.
¹⁸ Department of General Surgery, The First Affiliated Hospital, Henan University, Kaifeng, China.
¹⁹ Department of General Surgery, The First Affiliated Hospital, Henan University, Kaifeng, China; Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China. Electronic address: yangtianehbh@smmu.edu.cn.

PMID: 39615293
DOI: 10.1016/j.ejso.2024.109486

Abstract

Background & aims: Surgical site infection (SSI) is a common complication after hepatectomy for hepatocellular carcinoma (HCC), but its risk factors and impact on outcomes remain poorly characterized. We aimed to investigate the incidence, risk factors, and outcomes of SSI after hepatectomy for HCC and develop a prediction model.

Methods: This multicenter retrospective study included patients who underwent curative-intent hepatectomy for HCC across 15 Chinese hepatobiliary centers from 2010 to 2021. SSI was defined according to Centers for Disease Control and Prevention criteria. Logistic regression identified independent risk factors for SSI. A nomogram was developed and internally validated.

Results: Among 4124 patients, 393 (9.5 %) developed SSI; 76 (19.3 %) were diagnosed after discharge. SSI was associated with prolonged hospital stay (mean: 21 vs. 11 days), higher 30-day readmission (13.7 % vs. 3.2 %), and 90-day mortality (5.1 % vs. 2.9 %) (all P < 0.001). Independent risk factors for SSI were obesity (odds ratio [OR] 2.12), diabetes (OR 3.31), portal hypertension (OR 1.96), blood loss ≥400 mL (OR 1.75), open approach (OR 4.99), diaphragmatic incision (OR 2.27), major hepatectomy (OR 1.88), and operative time ≥180 min (OR 1.55). The nomogram model and online calculator (http://asapcalculate.top/Cal14_en.html) demonstrated good discrimination (C-index 0.733) and calibration.

Conclusions: SSI was common after hepatectomy for HCC and associated with worse short-term postoperative outcomes. The novel easy-to-use prediction calculator may facilitate individualized risk assessment and guide targeted preventive strategies. Future studies should focus on external validation and evaluating interventions in high-risk patients.

Keywords: Complications; Hepatectomy; Hepatocellular carcinoma; Incidence; Predictive model; Risk factor; Surgical site infection.