Whether one believes that all surgical site infections (SSIs) are preventable, procedure-specific SSI is increasingly used as a measure of surgical quality. Although its appropriateness as a quality measure can be debated, a better understanding of factors associated with SSI may inform strategies for risk reduction. However, the common practice of combining the 3 levels of SSI—superficial, deep, and organ-space—into a single SSI index may obfuscate through aggregation, particularly for complex intra-abdominal procedures such as pancreatic resection. In this issue of JAMA Surgery, Elliott and colleagues1 analyze single-institution and national hepatopancreaticobiliary-specific National Surgical Quality Improvement Program data for pancreatic resection to determine whether factors associated with wound infection are distinct from those associated with organ-space infection. Multivariate analysis indicated that the presence of a biliary stent was associated with wound infection but not organ-space SSI, whereas gland texture was more strongly associated with organ-space SSI (and was difficult to distinguish from the complication of pancreatic fistula).
Matthews JB. Infection After Pancreatic SurgerySuperficial and Deep Thoughts. JAMA Surg. Published online July 12, 2017. doi:10.1001/jamasurg.2017.2144