Reviewer ’s report  
 
Title: Predictors of surgical site infection after pancreaticoduodenectomy  
 
Version: 1 Date: 16 Feb 2020  
 
Reviewer's report:  
 
This manuscript was written about predictors of surgical site infection (SSI) after 
pancreaticoduodenectomy. This manuscript states some important issues regarding risk factors of 
SSI. However further analysis and discussion would be required to confirm this conclusion. 
Therefore, authors would clarify several matters that mentioned below to confirm these 
conclusions.  
 
1. The risk factors o f incisional SSI and those of organ/space SSI should be considered 
separately. Authors reported that POPF was the only independent risk factor for organ/space SSI 
(OR 8.79) and, for incisional SSI, POPF (OR 2.60) and prior biliary intervention (OR 3.17) we re 
significant risk factors for SSI. Therefore, table 2 should be created separately as each table for 
the risk factors of incisional SSI and those of organ/space SSI.  
 
2. Author reported that prior biliary intervention (OR 3.17) were a significant risk factor 
for incisional SSI, not organ/space SSI. Percutaneous transhepatic biliary drainage might be a 
risk factor of incisional SSI. However, endoscopic biliary drainage was reported to be used in 
most cases. Why did endoscopic biliary drainage adversely affect the incidence of incisional SSI, 
not organ/space SSI?  
 
3. Several studies have reported that preoperative cholangitis due to obstructive jaundice 
or obstruction of bili ary drainage tube caused SSI in the early postoperative period. Because, bile 
infection due to preoperative cholangitis might increase intra -abdominal bacterial infection. In 
this study, what frequency was preoperative cholangitis due to obstructive jaundi ce or 
obstruction of biliary drainage tube? Moreover, did preoperative cholangitis affect SSI in this 
study?  
 
4. Some important information regarding preoperative cholangitis after biliary drainage is 
absent in the manuscript, including method of treatment  for cholangitis, the period from 
preoperative biliary drainage until occurrence of preoperative cholangitis, preoperative bile 
culture results, antibiotics given for cholangitis, etc. Adding this if available would be helpful to 
understand the association  between biliary drainage and cholangitis.  
 
5. Several studies have reported that the period of surgical drain insertion affected the 
incidence of SSI. Authors describe about drain management such as criteria of drain removal or 
kinds of surgical drain in Method.  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in th e manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold an y stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial co mpeting interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree  to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website alon g with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named repor t can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Predictors of surgical site infection after pancreaticoduodenectomy  
 
Version: 1 Date: 16 Feb 2020  
 
Reviewer's report:  
 
This manuscript was written about predictors of surgical site infection (SSI) after 
pancreaticoduodenectomy. This manuscript states some important issues regarding risk factors of 
SSI. However further analysis and discussion would be required to confirm this conclusion. 
Therefore, authors would clarify several matters that mentioned below to confirm these 
conclusions.  
 
1. The risk factors o f incisional SSI and those of organ/space SSI should be considered 
separately. Authors reported that POPF was the only independent risk factor for organ/space SSI 
(OR 8.79) and, for incisional SSI, POPF (OR 2.60) and prior biliary intervention (OR 3.17) we re 
significant risk factors for SSI. Therefore, table 2 should be created separately as each table for 
the risk factors of incisional SSI and those of organ/space SSI.  
 
2. Author reported that prior biliary intervention (OR 3.17) were a significant risk factor 
for incisional SSI, not organ/space SSI. Percutaneous transhepatic biliary drainage might be a 
risk factor of incisional SSI. However, endoscopic biliary drainage was reported to be used in 
most cases. Why did endoscopic biliary drainage adversely affect the incidence of incisional SSI, 
not organ/space SSI?  
 
3. Several studies have reported that preoperative cholangitis due to obstructive jaundice 
or obstruction of bili ary drainage tube caused SSI in the early postoperative period. Because, bile 
infection due to preoperative cholangitis might increase intra -abdominal bacterial infection. In 
this study, what frequency was preoperative cholangitis due to obstructive jaundi ce or 
obstruction of biliary drainage tube? Moreover, did preoperative cholangitis affect SSI in this 
study?  
 
4. Some important information regarding preoperative cholangitis after biliary drainage is 
absent in the manuscript, including method of treatment  for cholangitis, the period from 
preoperative biliary drainage until occurrence of preoperative cholangitis, preoperative bile 
culture results, antibiotics given for cholangitis, etc. Adding this if available would be helpful to 
understand the association  between biliary drainage and cholangitis.  
 
5. Several studies have reported that the period of surgical drain insertion affected the 
incidence of SSI. Authors describe about drain management such as criteria of drain removal or 
kinds of surgical drain in Method.  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in th e manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold an y stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial co mpeting interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree  to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website alon g with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named repor t can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Predictors of surgical site infection after pancreaticoduodenectomy  
 
Version: 1 Date: 16 Feb 2020  
 
Reviewer's report:  
 
This manuscript was written about predictors of surgical site infection (SSI) after 
pancreaticoduodenectomy. This manuscript states some important issues regarding risk factors of 
SSI. However further analysis and discussion would be required to confirm this conclusion. 
Therefore, authors would clarify several matters that mentioned below to confirm these 
conclusions.  
 
1. The risk factors o f incisional SSI and those of organ/space SSI should be considered 
separately. Authors reported that POPF was the only independent risk factor for organ/space SSI 
(OR 8.79) and, for incisional SSI, POPF (OR 2.60) and prior biliary intervention (OR 3.17) we re 
significant risk factors for SSI. Therefore, table 2 should be created separately as each table for 
the risk factors of incisional SSI and those of organ/space SSI.  
 
2. Author reported that prior biliary intervention (OR 3.17) were a significant risk factor 
for incisional SSI, not organ/space SSI. Percutaneous transhepatic biliary drainage might be a 
risk factor of incisional SSI. However, endoscopic biliary drainage was reported to be used in 
most cases. Why did endoscopic biliary drainage adversely affect the incidence of incisional SSI, 
not organ/space SSI?  
 
3. Several studies have reported that preoperative cholangitis due to obstructive jaundice 
or obstruction of bili ary drainage tube caused SSI in the early postoperative period. Because, bile 
infection due to preoperative cholangitis might increase intra -abdominal bacterial infection. In 
this study, what frequency was preoperative cholangitis due to obstructive jaundi ce or 
obstruction of biliary drainage tube? Moreover, did preoperative cholangitis affect SSI in this 
study?  
 
4. Some important information regarding preoperative cholangitis after biliary drainage is 
absent in the manuscript, including method of treatment  for cholangitis, the period from 
preoperative biliary drainage until occurrence of preoperative cholangitis, preoperative bile 
culture results, antibiotics given for cholangitis, etc. Adding this if available would be helpful to 
understand the association  between biliary drainage and cholangitis.  
 
5. Several studies have reported that the period of surgical drain insertion affected the 
incidence of SSI. Authors describe about drain management such as criteria of drain removal or 
kinds of surgical drain in Method.  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in th e manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold an y stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial co mpeting interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree  to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website alon g with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named repor t can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant