The pre-operative risk of surgical site infection after liver resection
This model calculates the preoperative probability of developping a surgical site infection (SSI) after liver resection. SSI may either be an incisional infection or an intra-abdominal infection. Additional measures may be taken in patients with increased risk.

The model was created in a Dutch multicenter cohort study, and is based on logistic regression. The study included 982 liver resections, both benign and malignant indications.
Research authors: G.W. de Klein, M.J. Bruins, M.S.L. Liem, H. Eker, J.M. Klaase, V.B. Nieuwenhuijs
Details Formula Study characteristics Files & References
Model author
Model ID
Revision date
MeSH terms
  • Hepatectomy
  • Surgical Site Infection
  • Model type
    Logistic regression (Calculation)
    No Formula defined yet
    Condition Formula

    Additional information

    This cohort study used data from prospectively held databases from four high-volume HPB centers, including one academic center. All patients who underwent liver resection (primary and repeat) between 2013 and 2017 for both malignant and benign indications were included. Patients with trauma-related resections, donor hepatectomy, and patients who only underwent radiofrequency ablation (RFA) were excluded.
    Stepwise logistic regression was used to detect independent predictors for SSI. The predictors that were known preoperatively were used to create a nomogram to indicate the probability of the development of a SSI of individuals

    Study Population

    Total population size: 982
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    Females: {{ model.numberOfFemales }}

    Continuous characteristics

    Name Mean SD Unit
    Age 73 10 year
    BMI 26.5 4.5 kg/m²
    Name LL Q1 Median Q3 UL Unit
    Operative time 120 228 449 minutes
    Blood loss 200 400 775 mL

    Categorical characteristics

    Name Subset / Group Nr. of patients
    SSI Yes 80
    No 902
    Type resection Major 289
    Minor 693
    Simultaneous liver and colorectal resection Yes 154
    No 828
    Concomitant RFA No 869
    Yes 113
    Indication Colorectal metastasis 693
    Primary liver tumor 80
    Metastasis non-colorectal 56
    Benign 122
    Approach Open 836
    Laparoscopy 146
    Present liver disease No 956
    Hepatitis 17
    Cirrhosis 9
    Abdominal comorbidity No 891
    Yes 91
    Physical status classification ASA I 208
    ASA II 613
    ASA III 156
    ASA IV 4
    Diatabetes No 882
    Yes 100
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    Related files

    Supporting Publications

    The pre-operative risk of surgical site infection after liver resection is

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    The pre-operative risk of surgical site infection after liver resection is

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    Outcome stratification

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    Result interpretation

    Precautionary measures in high risk patients might include an extended antimicrobial prophylaxis, for instance based on rectal cultures that may be obtained preoperatively to detect colonization of resistant microbes and adjust antibiotic prophylaxis. Furthermore, a more extensive antiseptic regime for instance with chlorhexidine body wash preoperatively, the use of antimicrobial coated sutures, and the use of wound protectors or negative pressure wound therapy. Finally, enhanced nutritional support, and physical prehabilitation to optimize the immuno-nutritional status, might reduce the risk of SSI. See also the WHO Global guidelines on the prevention of surgical site infection.

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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