title: Additional surgical procedure is a risk factor for surgical site infections after laparoscopic cholecystectomy.
abstract: OBJECTIVE
  Surgical site infections (SSI) are associated with increased costs and length of hospital stay, readmission rates, and mortality. The aim of this study was to identify risk factors for SSI in patients undergoing laparoscopic cholecystectomy.
  
  
  METHODS
  Analysis of 35,432 laparoscopic cholecystectomies of a prospective multicenter database was performed. Risk factors for SSI were identified among demographic data, preoperative patients' history, and operative data using multivariate analysis.
  
  
  RESULTS
  SSIs after laparoscopic cholecystectomy were seen in 0.8 % (n = 291) of the patients. Multivariate analysis identified the following parameters as risk factors for SSI: additional surgical procedure (odds ratio [OR] 4.0, 95 % confidence interval [CI] 2.2-7.5), age over 55 years (OR 2.4 [1.8-3.2]), conversion to open procedure (OR 2.6 [1.9-3.6]), postoperative hematoma (OR 1.9 [1.2-3.1]), duration of operation >60 min (OR 2.5 [1.7-3.6], cystic stump insufficiency (OR 12.5 [4.2-37.2]), gallbladder perforation (OR 6.2 [2.4-16.1]), gallbladder empyema (OR 1.7 [1.1-2.7]), and surgical revision (OR 15.7 [10.4-23.7]. SSIs were associated with a significantly prolonged hospital stay (p < 0.001), higher postoperative mortality (p < 0.001), and increased rate of surgical revision (p < 0.001).
  
  
  CONCLUSIONS
  Additional surgical procedure was identified as a strong risk factor for SSI after laparoscopic cholecystectomy. Furthermore, operation time >60 min, age >55 years, conversion to open procedure, cystic stump insufficiency, postoperative hematoma, gallbladder perforation, gallbladder empyema, or surgical revision were identified as specific risk factors for SSI after laparoscopic cholecystectomy.
authors.affiliation: Division of Visceral Surgery and Medicine, University Hospital Bern, 3010, Bern, Switzerland.
authors.forename: René
authors.initials: R
authors.lastname: Fahrner
authors.forename: Thomas
authors.initials: T
authors.lastname: Malinka
authors.forename: Jennifer
authors.initials: J
authors.lastname: Klasen
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
authors.forename: Guido
authors.initials: G
authors.lastname: Beldi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000191:economics / Q000379:methods; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012086:Reoperation / Q000191:economics / Q000379:methods; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D013557:Switzerland; D055815:Young Adult
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