Surgical site infections following pediatric liver transplantation: risks and costs Abstract: Purpose. 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. Methods. 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. Results. 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 > 7h (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. Conclusions. 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. Orthotopic liver transplantation (OLT) has proven to be a successful treatment for end-stage liver disease in children (1±5). Five-year survival rates for pediatric liver transplants have improved from approximately 30% in 1980 to approximately 80% in 1998, in large part due to improve- ments in immunosuppression, organ preservation, and management of Presented at the American Pediatric Surgical Association 33rd annual meeting, May 20,2002, Phoenix, Arizona. 72 C.S. Hollenbeak E.J. Alfrey K. Sheridan T.L. Burger P.W. Dillon Key words: cost and risk analysis; pediatric liver transplantation; surgical site infections Received 15 July 2002, revised 21 January 2003, accepted for publication 7 March 2003 Copyright ß Blackwell Munksgaard 2003 Transplant Infectious Disease . ISSN 1398-2273 Transpl Infect Dis 2003: 5: 72±78 Printed in Denmark. All rights reserved Authors' affiliations: C.S. Hollenbeak 1,2 , E.J. Alfrey 3 , K. Sheridan 4 , T.L. Burger 5 , P.W. Dillon 6 1 Departments of Surgery and Health Evaluation Sciences, Penn State College of Medicine, Hershey, PA, USA, 2 Department of Health Studies, Lehigh Valley Hospital,Allentown,PA,USA, 3 Division of Transplantation, Department of Surgery, Penn State College of Medicine, Hershey, PA, USA, 4 Penn State College of Medicine, Hershey, PA, USA, 5 Infection Control Department, Lehigh Valley Hospital,Allentown,PA,USA, 6 Division of Pediatric Surgery, Department of Surgery, Penn State College of Medicine, Hershey, PA, USA Correspondence to: Christopher S. Hollenbeak Penn State College of Medicine PO Box 850 500 University Drive MC H113 Hershey, PA 17033 Tel: 717 531 5890 Fax: 717 531 4185 e-mail: chollenbeak@psu.edu