Impact of Wound Protectors on Complications Following Pancreaticoduodenectomy: A National Surgical Quality Improvement Program Analysis of 20 960 Patients

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BACKGROUND: Wound protectors (WPs) have been shown to decrease postoperative wound complications, yet limited data exist supporting WP for pancreaticoduodenectomies, with limited uptake in practice. We evaluated the effect of WP in pancreaticoduodenectomies on surgical site infections (SSIs) and serious complications. METHODS: Utilizing the National Surgical Quality Improvement Program database, we included patients undergoing pancreaticoduodenectomy between 2017 and 2021. Baseline demographics and complications were compared between WP and no WP cohorts. Multivariate logistic regression was performed to identify the effect of WP use on 30-day complications and factors associated with WP use. RESULTS: Of 20 960 patients, 6167 (29.4%) used a WP. WPs were more commonly used in lower ASA classes, more comorbid patients, and preoperative weight loss. WP use was associated with increased operative time but decreased length of stay, SSIs, organ space infection, pancreatic fistula, reoperation, and serious complication. WP was independently associated with decreased serious complication (aOR 0.80, p < 0.001) and SSI (aOR 0.57, p < 0.001). Factors associated with increased likelihood of WP use include preoperative weight loss, broad-spectrum antibiotic use, absence of bleeding disorder and firmer pancreatic texture. CONCLUSION: WP use during pancreaticoduodenectomy is associated with decreased number of postoperative complications and SSI. Future prospective randomized studies should assess cost-benefit and barriers to use to increase uptake of WP use.