Risk factors for surgical site infections following hepatobiliary surgery: An umbrella review and meta-analyses

Background

In the hepatobiliary (HPB) surgical cohort, surgical site infections (SSI) can extend hospital stays, result in higher morbidity, and poor patient outcomes. This umbrella review and meta-analysis aimed to synthesise the evidence for the association between clinical and patient risk factors and SSI in patients following HPB surgery.

Methods

We searched MEDLINE, CINAHL, EMBASE and Scopus from January 2000 to April 2023 to identify systematic reviews and meta-analyses where patient and/or clinical factors of SSIs following HPB surgery were reported. The summary effect size, its 95 % CI and the 95 % PI were calculated for each meta-analysis using random-effects models. 30-day cumulative SSI incidence was presented as the pooled estimate with 95 % CIs. Between-study heterogeneity was explored using the I² statistic.

Results

Nine systematic reviews and meta-analyses were included. Our findings suggest open surgical approach, type of pancreas procedure, preoperative biliary drainage, older age, male sex and high BMI (>25mg/k²) as statistically significant factors for increasing a patient's risk of SSI following HPB surgery. The cumulative incidence of SSI in the HPB cohort of 43,296 was 11 % (95 % CI 6%–20 %), with substantial variation between the reviews.

Conclusion

We identified several patient and clinical factors, however only one was graded as a high level of evidence.