Surgical Site Infection Rates in Laparoscopic Versus Open Colorectal Surgery

Abstract

The purpose of this study was to use the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to evaluate the incidence of postoperative surgical site infections (SSIs) between laparoscopic (LAP) and open colorectal surgery. The 2008 ACS-NSQIP Participant Use File was queried by Current Procedural Terminology codes for colorectal surgery cases. SSI rates were compared between groups using Pearson chi-square and Fisher exact tests. Univariate and multivariate analyses were performed to identify factors associated with the LAP approach and/or SSIs. A total of 7,755 LAP and 16,184 open cases were identified. The laparoscopic group had an SSI rate of 9.4 versus 15.7 per cent for the open group ( P < 0.0001). There was no statistical difference in the type of SSI (superficial, deep, and/or organ space) between the two groups. Although multivariate analysis identified several factors associated with SSIs of different types, LAP was the only factor found to decrease risk, whereas wound class and operative time were found to increase risk among all categories of SSIs. Despite a significantly lower incidence of postoperative SSI, only 32 per cent of colorectal surgery was performed laparoscopically in NSQIP hospitals in 2008. Wider adoption of LAP approaches for colorectal surgery should continue to reduce SSIs.

Current status of postoperative infections after digestive surgery in Japan: The Japan Postoperative Infectious Complications Survey in 2015

“…In the present survey, although the background of surgical procedures as well as the classification of benign or malignant disease differed between endoscopic and open surgery, PI were less frequent after endoscopic surgery, especially for esophageal surgery, gastrointestinal surgery, colorectal surgery, and cholecystectomy. Previous studies reported similar results regarding endoscopic surgery versus open surgery in esophageal surgery (23.5% vs 46.7%), gastrointestinal surgery (1.0% vs 1.8%‐8.9%), colorectal surgery (7.0%‐11.3% vs 15.7%‐25.0%), and cholecystectomy (0.6%‐5.9% vs 4.9%‐19.9%) . In the present survey, there was no incidence of PI after endoscopic esophageal surgery, although the procedures included only esophageal surgery for benign disease, such as esophageal achalasia, hiatus hernia, and selective vagotomy.…”

SSIs in Italy: Prevention and Surveillance during the Last Five Years

“…2) the total number of surgical procedures surveyed doubled over the study period. At the same time were confirmed some of the risk factors already known to be associated with an increased or reduced risk of SSIs, also for the Italian population: longer intervention duration, an ASA score of at least three and pre-surgery hospital stay of at least two days were found to be associated with an increased risk of SSI; on the other hand, laparoscopic procedures were associated with a reduction of SSIs rate [11]- [14] [29].…”

“…Overall, the incidence of SSI was significantly lower in laparoscopic (0.5%) than in open (1.8%) surgery (p < 0.01) [11]- [14].…”

Comparison of hand-assisted laparoscopic surgery and conventional laparotomy for rectal cancer: Interim results from a single center

“…Usually, single-center comparison of surgical procedures employs the CL group as a control; however, it is difficult to avoid bias of background factors in studies of pure LACS or HALS, as these procedures tend to be used for low-risk patients with a relatively good general condition, who are able to tolerate the oblique position with the head down, or patients with early-stage disease. In addition, it may be difficult to achieve unification of second-line treatment, including postoperative chemotherapy and radiotherapy, as well as treatment following recurrence (4)(5)(6)(7)(8)(9)(10). Moreover, if national clinical databases or guidelines are used as controls, the study becomes a stage-stratified comparison of outcomes with the national standards, which is not appropriate for comparing surgical procedures.…”

“…We are planning to perform a final analysis in the next 2 years. Studies comparing pure LACS with CL have identified problems with the former, including a longer operating time and increased cost, although the hospital stay is shorter and analgesic use is decreased (7)(8)(9)(10). There are also other problems with performing pure LACS at medium-sized hospitals with 400-500 beds, including the need for skilled surgeons, the training requirements, the pressure on the anesthesiologists due to longer operations, longer occupation of operating theaters and greater consumption of materials.…”