title: Laparoscopic surgery significantly reduces surgical-site infections compared with open surgery.
abstract: BACKGROUND
  Surgical-site infections (SSIs) are nosocomial infectious complications causing significant morbidity, mortality, and hospital costs. Recently, the US Department of Human Health Services and the Centers for Medicare and Medicare Services outlined measures intended to decrease and prevent hospital-acquired infections such as SSI. This study aimed to compare the incidence of SSI after laparoscopic and open surgery.
  
  
  METHODS
  A retrospective analysis of a large administrative, clinical, and financial database (University Health System Consortium) of US Academic Medical Centers and affiliated community hospitals was conducted. Patients who underwent laparoscopic (n = 94,665) or open (n = 36,965) appendectomy, cholecystectomy, antireflux surgery, or gastric bypass between 2004 and 2008 were included in the analysis. The main outcome measure was inpatient diagnosis of SSI after laparoscopic and open surgery.
  
  
  RESULTS
  During the 45-month study period, a total of 131,630 patients underwent one of four selected procedures. Overall, the incidence of SSI was significantly lower in laparoscopic (483 of 94,665, 0.5%) than in open (669 of 36,965, 1.8%) surgery (p < 0.01). Largely, laparoscopic techniques offered a protective effect against SSI (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.25-0.31). Patients treated with laparoscopy were 72% less likely to experience an SSI. This protective effect was shown to be sustained after stratification by severity of illness (minor: OR, 0.19; 95% CI, 0.14-0.26; moderate: OR, 0.30; 95% CI, 0.25-0.35; major/extreme: OR, 0.65; 95% CI, 0.54-0.79), admission status (elective: OR, 0.25; 95% CI, 0.20-0.31; urgent: OR, 0.38; 95% CI, 0.28-0.53; emergent: OR, 0.29; 95% CI, 0.25-0.34), and wound classification (dirty wounds: OR, 0.45; 95% CI, 0.37-0.54).
  
  
  CONCLUSIONS
  In US academic medical centers, laparoscopy significantly reduces SSI. Patients treated with laparoscopic procedures are less likely to experience SSI. After stratification by severity of illness, admission status, and wound classification, laparoscopic techniques showed a protective effect against SSI.
authors.affiliation: Minimally Invasive Surgery, Veteran Affairs North Texas Healthcare System, Dallas, TX 75216, USA. esteban.varela@utsouthwestern.edu
authors.forename: J Esteban
authors.initials: JE
authors.lastname: Varela
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Wilson
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology; D055815:Young Adult