Surgical site infections following pediatric liver transplantation: risks and costs

Infectious complications following orthotopic liver transplantation (OLT) represent a significant cause of morbidity and mortality in both adults and children. In adults, surgical site infections complicating OLT have been shown to significantly increase resource utilization, but their impact in children has not been studied. In this study we identify risk factors for surgical site infections in children undergoing primary OLT for end-stage liver disease and estimate their impact on patient survival, graft survival, length of stay, and charges.

All pediatric liver transplants (n = 77) less than 16 years of age from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Liver Transplantation Database were included in the analysis. Surgical site infections (n = 25) were defined as wound infections, abdominal abscesses, and bacterial or fungal infections of the liver, intestine, or peritoneum during the initial transplant admission. Risk of infection was estimated using logistic regression, survival rates were estimated using the Kaplan-Meier method, and length of stay and charges were compared using Student's t-test. Multivariate analysis of charges was performed using linear regression.

Of the 77 patients, 25 (32.5%) developed a surgical site infection. Several factors were associated with increased risk of infections, including a leak at the biliary anastomosis (odds ratio [OR] 115, P = 0.003), preoperative white blood cell count (OR = 1.28, P = 0.009), surgery > 7 h (OR = 15.0, P = 0.011), HLA mismatches (OR = 6.0, P = 0.03), and female gender (OR = 8.0, P = 0.038). Surgical site infections did not significantly decrease either patient survival or graft survival, and increased hospital stay by an average of 21 days (P = 0.14). After controlling for other factors, patients who developed surgical site infections incurred on average $132,507 (P = 0.03) more in charges than patients who did not develop infections.

Surgical site infections in pediatric patients following liver transplantation are significantly influenced by surgical technique and endogenous patient characteristics. Though survival outcomes are not different, the development of such infections has significant implications for resource utilization in the care of these patients.