Laparoscopic Approach Significantly Reduces Surgical Site Infections after Colorectal Surgery: Data from National Surgical Quality Improvement Program

• Published in: Journal of the American College of Surgeons Vol. 211; no. 2; pp. 232 - 238
• Main Authors: Kiran, Ravi P., MD, El-Gazzaz, Galal Hussein, MD, PhD, Vogel, Jon D., MD, Remzi, Feza H., MD, FACS
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2010; Elsevier
• Subjects: Biological and medical sciences; Colectomy - methods; Colonic Diseases - surgery; Digestive system. Abdomen; Endoscopy; Female; Follow-Up Studies; General aspects; Human infectious diseases. Experimental studies and models; Humans; Incidence; Infectious diseases; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy - methods; Laparotomy - adverse effects; Male; Medical sciences; Middle Aged; Program Evaluation; Quality Assurance, Health Care - methods; Rectal Diseases - surgery; Retrospective Studies; Risk Factors; Surgery; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control; United States - epidemiology; United States; American College of Surgeons-National Surgical Quality Improvement Program; body mass index; ACS-NSQIP; surgical site infection; SSI; laparoscopic; American Society of Anesthesiologists; LAP; ASA; BMI; Medicine; Surgical wound; Endoscopic surgery; Nosocomial infection; Improvement; Program; Treatment; Quality; Observation data; Surgical approach; Laparoscopy; Endoscopy
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2010.03.028

Background The goal of this study was to compare surgical site infection (SSI) rates between laparoscopic (LAP) and open colorectal surgery using the National Surgical Quality Improvement Program (NSQIP) database. Study Design We identified patients included in the NSQIP database from 2006 to 2007 who underwent LAP and open colorectal surgery. SSI rates were compared for the 2 groups. Association between patient demographics, diagnosis, type of procedure, comorbidities, laboratory values, intraoperative factors, and SSI within 30 days of surgery, were determined using a logistic regression analysis. Results Among 10,979 patients undergoing colorectal surgery (LAP 31.1%, open 68.9%), the SSI rate was 14.0% (9.5% LAP vs 16.1% open, p < 0.001). LAP patients were younger (p < 0.001), with lower American Society of Anesthesiologists (ASA) scores (p < 0.001) and comorbidities (p = 0.001) involving benign and inflammatory conditions rather than malignancy (p < 0.001), but operative time was greater (p = 0.001). On multivariate analysis age, ASA ≥3, smoking, diabetes, operative time >180 minutes, appendicitis or diverticulitis, and regional enteritis diseases were found to be significantly associated with high SSI; the LAP approach was associated with a reduced SSI rate. Conclusions The LAP approach is independently associated with a reduced SSI when compared with open surgery and should, when feasible, be considered for colon and rectal conditions.