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Multicenter Study
. 2025 Feb;51(2):109486.
doi: 10.1016/j.ejso.2024.109486. Epub 2024 Nov 22.

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

Yang Shen  1 , Yi-Lin Hu  2 , Jia-Hao Xu  3 , Shuo Zhu  1 , Lei Cai  4 , Yi-Fan Wu  5 , Xiao-Chang Wu  6 , Yong-Yi Zeng  7 , Wei-Min Gu  8 , Ya-Hao Zhou  9 , Ying-Jian Liang  10 , Hong Wang  11 , Ting-Hao Chen  12 , Da-Qun Liu  13 , Yao-Ming Zhang  14 , Xian-Ming Wang  15 , Ming-Da Wang  3 , Han Wu  3 , Chao Li  3 , Yong-Kang Diao  3 , Li-Hui Gu  3 , Lan-Qing Yao  3 , Alfred Wei Chieh Kow  16 , Timothy M Pawlik  17 , Fei Wu  18 , Xiao-Lei Wang  18 , Feng Shen  3 , Tian Yang  19
Affiliations
Multicenter Study

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

Yang Shen et al. Eur J Surg Oncol. 2025 Feb.

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.

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Conflict of interest statement

Declaration of competing interest Neither the entire manuscript nor any part of its content has been published or has been accepted elsewhere and this manuscript has not been submitted to any other journal. No portion of the text has been copied from other material in the literature. All of the authors in this manuscript have read and approved the final version submitted, and there are no conflicts involved in this submission.

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