Effect of minimally invasive surgery on the risk for surgical site infections results from the national surgical quality improvement program (nsqip) database

Giorgio Gandaglia, Khurshid R. Ghani, Akshay Sood, Jessica R. Meyers, Jesse D. Sammon, Marianne Schmid, Briony Varda, Alberto Briganti, Francesco Montorsi, Maxine Sun, Mani Menon, Adam S. Kibel, Quoc Dien Trinh

Research output: Contribution to journalArticlepeer-review

Abstract

IMPORTANCE Surgical site infection (SSI) represents the second most common cause of hospital-acquired infection and the most common type of infection in patients undergoing surgery. However, evidence is scarce regarding the effect of the surgical approach (open surgery vs minimally invasive surgery [MIS]) on the risk for SSIs.

OBJECTIVE To evaluate the role of the surgical approach on the risk for SSIs in a large contemporary cohort of patients undergoing surgery across different specialties.

DESIGN, SETTING, AND PARTICIPANTS The American College of Surgeons National Surgical Quality Improvement Program database is a national, prospective perioperative database specifically developed to assess quality of surgical care.We queried the database from January 1, 2005, through December 31, 2011, for patients undergoing appendectomy (n = 97 780), colectomy (n = 118 407), hysterectomy (n = 26 639), or radical prostatectomy (n = 11 183).

EXPOSURES Thirty-day SSIs.

MAIN OUTCOMES AND MEASURES We abstracted the data on 30-day SSIs and compared patients undergoing open procedures and MIS using propensity score matching. Logistic regression analyses of the matched cohorts tested the association between the surgical approach and risk for SSIs.

RESULTS The overall 30-day rates of SSIs were 5.4%for appendectomy, 12.1% for colectomy, 2.8%for hysterectomy, and 1.7%for prostatectomy. After propensity score matching, MIS was associated with lower rates of postoperative SSIs in patients undergoing MIS vs open procedures for appendectomy (3.8% vs 7.0%; P <.001), colectomy (9.3%vs 15.0%; P <.001), hysterectomy (1.8%vs 3.9%; P <.001), and radical prostatectomy (1.0% vs 2.4%; P <.001). In logistic regression analyses, MIS was associated with lower odds of SSIs in patients treated with appendectomy (odds ratio [OR], 0.52 [95%CI, 0.48-0.58]; P <.001), colectomy (OR, 0.58 [95%CI, 0.55-0.61]; P <.001), hysterectomy (OR, 0.44 [95%CI, 0.37-0.53]; P <.001), and radical prostatectomy (OR, 0.39 [95%CI, 0.25-0.61]; P <.001).

CONCLUSIONS AND RELEVANCE The proportion of patients developing SSIs within 30 days after surgery can be substantial and depends on the type of surgery. Minimally invasive surgery is significantly associated with reduced odds of SSIs. This advantage should be considered when assessing the overall benefits of minimally invasive techniques. Copyright

Original languageEnglish
Pages (from-to)1039-1044
Number of pages6
JournalJAMA Surgery
Volume149
Issue number10
DOIs
Publication statusPublished - Oct 1 2014

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

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