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The association between the increased performance of laparoscopic colon surgery and a reduced risk of surgical site infection.

ABSTRACT: PURPOSE:Surgical site infection (SSI) is the most frequently occurring nosocomial infection. Remarkable surgical progress has recently been made in laparoscopic surgery. Therefore, our objective was to investigate the association between increased rates of laparoscopic colon surgery and SSI. METHODS:We retrospectively investigated SSI surveillance data from July 2003 to December 2015. Two university hospitals and 25 university-affiliated hospitals participated in prospective SSI surveillance. Univariate and multivariate analyses were performed to detect significant associations. RESULTS:We investigated 9655 colon surgeries. The year in which surgery was performed was significantly associated with the SSI rate (p?=?0.0381). The rate of laparoscopic surgery gradually increased during the study period, and by 2012 it was routinely used for >?50% of colon surgeries. Laparoscopic surgery became a significant factor associated with reduced SSI rates compared with conventional open surgery once the performance rate of laparoscopic surgery reached?>?50%. CONCLUSIONS:Increasing rates of laparoscopic colon surgery tended to be associated with a reduction in the SSI risk after surgical treatment of colonic disease. The results of this study might encourage surgeons to view laparoscopic surgical techniques as an evidence-based approach for reducing the risk of SSI.

SUBMITTER: Kagawa Y

PROVIDER: S-EPMC6526142 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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The association between the increased performance of laparoscopic colon surgery and a reduced risk of surgical site infection.

Kagawa Yoshinori Y Yamada Daisaku D Yamasaki Makoto M Miyamoto Atsushi A Mizushima Tsunekazu T Yamabe Kazuo K Imazato Mitsunobu M Fukunaga Hiroki H Kobayashi Shogo S Shimizu Junzo J Umeshita Koji K Ito Toshinori T Doki Yuichiro Y Mori Masaki M

Surgery today 20190125 6

<h4>Purpose</h4>Surgical site infection (SSI) is the most frequently occurring nosocomial infection. Remarkable surgical progress has recently been made in laparoscopic surgery. Therefore, our objective was to investigate the association between increased rates of laparoscopic colon surgery and SSI.<h4>Methods</h4>We retrospectively investigated SSI surveillance data from July 2003 to December 2015. Two university hospitals and 25 university-affiliated hospitals participated in prospective SSI s ...[more]

PMID: 30684051

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Project description:Importance:Colon surgery is associated with a high rate of surgical site infection (SSI), and there is an urgent need for strategies to reduce infection rates. Objective:To assess whether laparoscopic colon surgery is associated with a lower surgical site infection rate than open-approach laparoscopy, especially in patients with medically complex conditions. Design, Setting, and Participants:This cohort study used previously validated diagnosis and procedure codes from Medicare beneficiaries who underwent colon surgery from January 1, 2009, to November 30, 2013. Analyses were performed from August 1 to December 31, 2018. Main Outcomes and Measures:Outcome measures were SSI events, medical comorbidities, and laparoscopic or open approach procedures. Results:A total of 229 726 patients (mean [SD] age, 74.3 [9.4] years; 128 499 [55.9%] female) underwent colon procedures. There were 105 144 laparoscopic procedures and 124 582 open procedures. The overall mean SSI rate was 6.2%, varying by surgical procedure from 5.8% to 7.6%. Among the full study population, adjusted model results showed a significant association of laparoscopy with lower odds of SSI (odds ratio, 0.43; 95% CI, 0.41-0.46; P < .001). When stratified by surgical approach, the mean SSI rates were 4.1% (procedure-specific range, 3.9%-5.1%) for the laparoscopic approach and 7.9% (procedure-specific range, 7.4%-10.2%) for the open approach. When stratified by Elixhauser score groups, the mean SSI rates were 6.2% (procedure-specific range, 3.2%-8.7%) for group 1 (0-1 comorbidity), 5.5% (procedure-specific range, 3.6%-11.1%) for group 2 (2 comorbidities), and 6.6% (procedure-specific range, 4.6%-10.6%) for group 3 (3-13 comorbidities). An interaction was also observed between laparoscopic approach and Elixhauser groups, with increased odds of SSI among patients who had 3 to 13 comorbidities present at the time of the procedure (odds ratio, 1.21; 95% CI, 1.11-1.32) compared with patient groups with fewer comorbidities. The population attributable fraction of SSIs for use of the open approach was 34.2%. A total of 2317 of 3882 hospitals (59.7%) performed few (0%-10%) or most (>50%) procedures laparoscopically. Conclusions and Relevance:Policy changes that promote surgical education and resources for laparoscopy, especially at low-adoption hospitals, may be associated with reduced colon SSI rates. Support of the development of innovative educational policies may help achieve improvement in patient outcomes and decreased health care use in colon surgery.

Dataset Information

The association between the increased performance of laparoscopic colon surgery and a reduced risk of surgical site infection.

Publications

The association between the increased performance of laparoscopic colon surgery and a reduced risk of surgical site infection.

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