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Can Prophylactic Drains After Pancreaticoduodenectomy Be A Risk Factor for Organ/Space Surgical Site Infection?

Takashi Orii, Yukihiko Karasawa, Hiroe Kitahara, Masaki Yoshimura

Introduction Although some authors have reported that retrograde infection by longterm placement of prophylactic drain may be the main cause of organ/space surgical site infection after pancreaticoduodenectomy. Materials and Methods The study included 93 patients who underwent pancreaticoduodenectomy. We assessed the risk factors for organ/space surgical site infection and examined the microorganisms detected at organ/space surgical site infection to determine the origin of microorganisms. Results Of the 93 patients, 29 were included in the organ/space surgical site infection+ group. The risk factors for organ/space surgical site infection on univariate analysis were blood transfusion (OR, 2.70; p <0.05), the amount of peritoneal lavage <5,000 mL (OR, 3.08; p<0.05), open type of prophylactic drain (OR, 2.92; p<0.05), and the incidence of pancreatic fistula (OR, 7.54, p<0.001). The microorganisms, detected in cultured specimen from prophylactic drain at organ/space surgical site infection, belonged to intestinal flora in 22 out of 29 patients (75.9%), and 30 of all 48 detected microorganisms (62.5%) were occupied by those of intestinal flora. Conclusion We confirmed that pancreatic fistula was the most significant risk factor. Based on the microorganisms identified, retrograde infection via drain placement could not be confirmed; therefore, the time of the drain removal should be carefully considered.