The effects of laparoscopic cholecystectomy, hysterectomy, and appendectomy on nosocomial infection risks.
BACKGROUND
Recent reviews of the literature have concluded that additional, well-defined studies are required to clarify the superiority of laparoscopic or open surgery. This paper presents precise estimates of nosocomial infection risks associated with laparoscopic as compared to open surgery in three procedures: cholecystectomy, appendectomy, and hysterectomy.


METHODS
A retrospective analysis was performed on 11,662 admissions from 22 hospitals that have a nosocomial infection monitoring system. The Nosocomial Infection Marker (NIMtrade mark, patent pending) was used to identify nosocomial infections during hospitalization and post discharge. The dataset was limited to admissions with laparoscopic or open cholecystectomy (32.7%), appendectomy (24.0%), or hysterectomy (43.3%) and was analyzed by source of infection: urinary tract, wounds, respiratory tract, bloodstream, and others. Single- and multivariable logistic regression analyses were performed to control for the following potentially confounding variables: gender, age, type of insurance, complexity of admission on presentation, admission through the emergency department, and hospital case mix index (CMI).


RESULTS
Analyses were based on 399 NIMs in 337 patients. Laparoscopic cholecystectomy and hysterectomy each reduced the overall odds of acquiring nosocomial infections by more than 50% (p < 0.01) Laparoscopic cholecystectomy and hysterectomy also resulted in statistically significantly fewer readmissions with nosocomial infections (p < 0.01). Excluding appendectomy, the odds ratio for laparoscopic versus open NIM-associated readmission was 0.346 (p < 0.01). Laparoscopic appendectomy did not significantly change the odds of acquiring nosocomial infections.


CONCLUSIONS
As compared to open surgery, laparoscopic cholecystectomy and hysterectomy are associated with statistically significantly lower risks for nosocomial infections. For appendectomy, when comparing open versus laparoscopic approaches, no differences in the rate of nosocomial infections were detected.
Brill
Andrew
A
California Pacific Medical Center, San Francisco, USA.
Ghosh
Kathakali
K
Gunnarsson
Candace
C
Rizzo
John
J
Fullum
Terrence
T
Maxey
Craig
C
Brossette
Stephen
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001062:Appendectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*