Key result
Open surgery increased surgical site infection risk by 78% compared to laparoscopy, and every 30-minute increase in operative time independently increased SSI risk by 12%.
Why the study?
Does a laparoscopic approach reduce surgical site infections compared to an open approach in patients undergoing common surgical procedures?
Observational (n=226,006)
Does a laparoscopic approach reduce surgical site infections compared to an open approach in patients undergoing common surgical procedures?
Effect estimate: 78% risk increase for open surgery
Laparoscopic surgery is associated with shorter operative times, lower costs, shorter length of stay, and a significantly lower risk of surgical site infections compared to open surgery.
Supports laparoscopic preference to lower SSI where feasible; leaves open causal confirmation by RCTs.
Objective: To evaluate the relationship between operative approach, operative time, and SSI rate. Methods: Inpatient database review identified patients undergoing 5 common procedures from 1/2010-12/2011. Patients were stratified into laparoscopic or open approaches. The main outcome measure was the relationship between operative time and SSI by approach. Results: 226,006 patients were evaluated- 28.2% open and 71.8% laparoscopic. Mean overall operative time was significantly shorter laparoscopically (p<0.001). Laparoscopy was associated with significantly lower costs and shorter length of stay (LOS) overall and for each procedure(p<0.0001). Multivariate analysis found SSI increased directly with operative time: for every 30-minute increase, SSI risk increased by 12%. Operative approach was an independent risk factor for SSI: open surgery increased SSI risk by 78%. A direct relationship between open procedures, operative time, and SSI risk was found. Conclusions: Laparoscopy has overall shorter operative time and improved outcomes in SSI rate, LOS, and total costs for common surgical procedures. As operative time and approach were independent risk factors for SSI, the use of laparoscopy and operative time are valuable quality measures.
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Keller et al. (2015) conducted an observational in Patients undergoing 5 common surgical procedures (n=226,006). Laparoscopic surgery vs. Open surgery was evaluated on Surgical site infection (SSI) rate (78% risk increase for open surgery). Open surgery increased surgical site infection risk by 78% compared to laparoscopy, and every 30-minute increase in operative time independently increased SSI risk by 12%.
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