title: Laparoscope use and surgical site infections in digestive surgery.
abstract: 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.
authors: Department of Surgery, Mid-Valais Hospital Center, Sion, Switzerland.
authors: Sébastien
authors: S
authors: Romy
authors: Marie-Christine
authors: MC
authors: Eisenring
authors: Vincent
authors: V
authors: Bettschart
authors: Christiane
authors: C
authors: Petignat
authors: Patrick
authors: P
authors: Francioli
authors: Nicolas
authors: N
authors: Troillet
mesh_terms: 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*