title: Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program.
abstract: 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.
  
  
  METHODS
  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 > or = 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.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA. kiranp@ccf.org
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.forename: Galal Hussein
authors.initials: GH
authors.lastname: El-Gazzaz
authors.forename: Jon D
authors.initials: JD
authors.lastname: Vogel
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
mesh_terms: D003082:Colectomy / Q000379:methods*; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods*; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D014481:United States / Q000453:epidemiology