Laparoscope use and surgical site infections in digestive surgery.
OBJECTIVE
To compare surgical site infection (SSI) rates in open or laparoscopic appendectomy, cholecystectomy, and colon surgery. To investigate the effect of laparoscopy on SSI in these interventions.


BACKGROUND
Lower rates of SSI have been reported among various advantages associated with laparoscopy when compared with open surgery, particularly in cholecystectomy. However, biases such as the lack of postdischarge follow-up and confounding factors might have contributed to the observed differences between the 2 techniques.


METHODS
This observational study was based on prospectively collected data from an SSI surveillance program in 8 Swiss hospitals between March 1998 and December 2004, including a standardized postdischarge follow-up. SSI rates were compared between laparoscopic and open interventions. Factors associated with SSI were identified by using logistic regression models to adjust for potential confounding factors.


RESULTS
SSI rates in laparoscopic and open interventions were respectively 59/1051 (5.6%) versus 117/1417 (8.3%) in appendectomy (P = 0.01), 46/2606 (1.7%) versus 35/444 (7.9%) in cholecystectomy (P < 0.0001), and 35/311 (11.3%) versus 400/1781 (22.5%) in colon surgery (P < 0.0001). After adjustment, laparoscopic interventions were associated with a decreased risk for SSI: OR = 0.61 (95% CI 0.43-0.87) in appendectomy, 0.27 (0.16-0.43) in cholecystectomy, and 0.43 (0.29-0.63) in colon surgery. The observed effect of laparoscopic techniques was due to a reduction in the rates of incisional infections, rather than in those of organ/space infections.


CONCLUSIONS
When feasible, a laparoscopic approach should be preferred over open surgery to lower the risks of SSI.
Romy
Sébastien
S
Department of Surgery, Mid-Valais Hospital Center, Sion, Switzerland.
Eisenring
Marie-Christine
MC
Bettschart
Vincent
V
Petignat
Christiane
C
Francioli
Patrick
P
Troillet
Nicolas
N
D000293:Adolescent; D000328:Adult; D001062:Appendectomy / Q000009:adverse effects; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods; D003082:Colectomy / Q000009:adverse effects; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*