Differences in risk factors for surgical site infection between laparotomy and laparoscopy in gastrointestinal surgery

Abstract

Extensive gastrointestinal surgery surveillance data in Japan were analyzed to examine the differences in the risk factors for surgical site infection (SSI) between laparotomy and laparoscopic abdominal procedures. Surgical procedures investigated in the study were gastrectomy, cholecystectomy, colectomy, rectal resection, and appendectomy. A total of 32,629 patients were included in the study. The study participants were divided into two groups according to the year of surgery, 2003–2009 (first study period) and 2010–2015 (second study period), due to the increase in the number of laparoscopic surgeries in the second study period. The incidence of SSI was stratified by three SSI classifications (superficial incisional, deep incisional, and organ/space SSI). Multiple logistic regression analysis was performed to predict the risk factors for SSI. The percentage of laparoscopic surgeries performed has increased linearly since 2010. Patients in the second study period were significantly older and had a higher prevalence of SSI risk factors compared with those in the first study period. In addition, the predictive factors changed substantially in most surgical procedures between the two study periods. Wound class ≥ 3 was a ubiquitous risk factor for superficial incisional SSI (SI-SSI) and organ/space SSI (OS-SSI) in both open (laparotomy) and laparoscopic procedures in the first study period. Meanwhile, in the second study period, operative duration was a ubiquitous risk factor in both procedures. The risk factors for SI-SSI differed from those for OS-SSI in the five abdominal surgeries investigated in the study. Periodic examination of risk factors for SSI is recommended in an aging society.

Risk factors for surgical site infection in patients with gastric cancer: A meta‐analysis

“…Among the surgical operation factors, our review showed that operation time ≥3 h, laparotomy operation and blood transfusion significantly increased the risk of SSI in patients with gastric cancer. In our study, we found that operation time ≥3 h and laparotomy could increase the risk of SSI in gastric cancer patients by 8.33 times and 2.18 times, respectively, which was consistent with previous studies 46‐48 . Operation time was considered to reflect complexity of the surgery 49 and it could increase the risk of SSI in gastric cancer patients by 1.52 times 48 .…”

“…In our study, we found that operation time ≥3 h and laparotomy could increase the risk of SSI in gastric cancer patients by 8.33 times and 2.18 times, respectively, which was consistent with previous studies. [46][47][48] Operation time was considered to reflect complexity of the surgery 49 and it could increase the risk of SSI in gastric cancer patients by 1.52 times. 48 Inokuchi et al also found that laparotomy surgery was associated with a significantly higher incidence of SSI than laparoscopic surgery, the former could increase the risk of SSI in gastric cancer patients by 0.5 times.…”

Safety of laparoscopic cholecystectomy in patients with a cerebrospinal fluid shunt in the peritoneal cavity

“…However, there are no reports comparing the safety of open cholecystectomy with that of laparoscopic cholecystectomy in patients with CSF shunts. Open cholecystectomy is more invasive and associated with a higher risk for surgical site infection compared to laparoscopic cholecystectomy 36,37 . Compared to laparoscopic cholecystectomy, more invasive surgeries, such as gastrectomy and colorectal surgery can be performed without shunt intervention if uncontaminated 23–27 .…”

“…Open cholecystectomy is more invasive and associated with a higher risk for surgical site infection compared to laparoscopic cholecystectomy. 36,37 Compared to laparoscopic cholecystectomy, more invasive surgeries, such as gastrectomy and colorectal surgery can be performed without shunt intervention if uncontaminated. [23][24][25][26][27] Therefore, shunt intervention may not be necessary as long as the surgical field is uncontaminated, even if inflammation is severe and open or conversion to open cholecystectomy is needed.…”

Prevention of incisional surgical site infection by subfascial closed suction drainage after open laparotomy

“…Open laparotomy with gastroenterological surgery is a surgical procedure that is performed with a cleancontaminated wound by wound classi cation [1,2]. Thus, it often results in a relatively high rate (about 10% or more) of incisional SSI [3,4,5].…”