Effect of minimally invasive surgery on the risk for surgical site infections: results from the National Surgical Quality Improvement Program (NSQIP) Database
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Effect of minimally invasive surgery on the risk for surgical site infections: results from the National Surgical Quality Improvement Program (NSQIP) Database. / Gandaglia, Giorgio; Ghani, Khurshid R; Sood, Akshay; Meyers, Jessica R; Sammon, Jesse D; Schmid, Marianne; Varda, Briony; Briganti, Alberto; Montorsi, Francesco; Sun, Maxine; Menon, Mani; Kibel, Adam S; Trinh, Quoc-Dien.
in: JAMA SURG, Jahrgang 149, Nr. 10, 01.10.2014, S. 1039-1044.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Effect of minimally invasive surgery on the risk for surgical site infections: results from the National Surgical Quality Improvement Program (NSQIP) Database
AU - Gandaglia, Giorgio
AU - Ghani, Khurshid R
AU - Sood, Akshay
AU - Meyers, Jessica R
AU - Sammon, Jesse D
AU - Schmid, Marianne
AU - Varda, Briony
AU - Briganti, Alberto
AU - Montorsi, Francesco
AU - Sun, Maxine
AU - Menon, Mani
AU - Kibel, Adam S
AU - Trinh, Quoc-Dien
PY - 2014/10/1
Y1 - 2014/10/1
N2 - IMPORTANCE: Surgical site infection (SSI) represents the second most common cause of hospital-acquired infection and the most common type of infection in patients undergoing surgery. However, evidence is scarce regarding the effect of the surgical approach (open surgery vs minimally invasive surgery [MIS]) on the risk for SSIs.OBJECTIVE: To evaluate the role of the surgical approach on the risk for SSIs in a large contemporary cohort of patients undergoing surgery across different specialties.DESIGN, SETTING, AND PARTICIPANTS: The American College of Surgeons National Surgical Quality Improvement Program database is a national, prospective perioperative database specifically developed to assess quality of surgical care. We queried the database from January 1, 2005, through December 31, 2011, for patients undergoing appendectomy (n = 97,780), colectomy (n = 118,407), hysterectomy (n = 26,639), or radical prostatectomy (n = 11,183).EXPOSURES: Thirty-day SSIs.MAIN OUTCOMES AND MEASURES: We abstracted the data on 30-day SSIs and compared patients undergoing open procedures and MIS using propensity score matching. Logistic regression analyses of the matched cohorts tested the association between the surgical approach and risk for SSIs.RESULTS: The overall 30-day rates of SSIs were 5.4% for appendectomy, 12.1% for colectomy, 2.8% for hysterectomy, and 1.7% for prostatectomy. After propensity score matching, MIS was associated with lower rates of postoperative SSIs in patients undergoing MIS vs open procedures for appendectomy (3.8% vs 7.0%; P < .001), colectomy (9.3% vs 15.0%; P < .001), hysterectomy (1.8% vs 3.9%; P < .001), and radical prostatectomy (1.0% vs 2.4%; P < .001). In logistic regression analyses, MIS was associated with lower odds of SSIs in patients treated with appendectomy (odds ratio [OR], 0.52 [95% CI, 0.48-0.58]; P < .001), colectomy (OR, 0.58 [95% CI, 0.55-0.61]; P < .001), hysterectomy (OR, 0.44 [95% CI, 0.37-0.53]; P < .001), and radical prostatectomy (OR, 0.39 [95% CI, 0.25-0.61]; P < .001).CONCLUSIONS AND RELEVANCE: The proportion of patients developing SSIs within 30 days after surgery can be substantial and depends on the type of surgery. Minimally invasive surgery is significantly associated with reduced odds of SSIs. This advantage should be considered when assessing the overall benefits of minimally invasive techniques.
AB - IMPORTANCE: Surgical site infection (SSI) represents the second most common cause of hospital-acquired infection and the most common type of infection in patients undergoing surgery. However, evidence is scarce regarding the effect of the surgical approach (open surgery vs minimally invasive surgery [MIS]) on the risk for SSIs.OBJECTIVE: To evaluate the role of the surgical approach on the risk for SSIs in a large contemporary cohort of patients undergoing surgery across different specialties.DESIGN, SETTING, AND PARTICIPANTS: The American College of Surgeons National Surgical Quality Improvement Program database is a national, prospective perioperative database specifically developed to assess quality of surgical care. We queried the database from January 1, 2005, through December 31, 2011, for patients undergoing appendectomy (n = 97,780), colectomy (n = 118,407), hysterectomy (n = 26,639), or radical prostatectomy (n = 11,183).EXPOSURES: Thirty-day SSIs.MAIN OUTCOMES AND MEASURES: We abstracted the data on 30-day SSIs and compared patients undergoing open procedures and MIS using propensity score matching. Logistic regression analyses of the matched cohorts tested the association between the surgical approach and risk for SSIs.RESULTS: The overall 30-day rates of SSIs were 5.4% for appendectomy, 12.1% for colectomy, 2.8% for hysterectomy, and 1.7% for prostatectomy. After propensity score matching, MIS was associated with lower rates of postoperative SSIs in patients undergoing MIS vs open procedures for appendectomy (3.8% vs 7.0%; P < .001), colectomy (9.3% vs 15.0%; P < .001), hysterectomy (1.8% vs 3.9%; P < .001), and radical prostatectomy (1.0% vs 2.4%; P < .001). In logistic regression analyses, MIS was associated with lower odds of SSIs in patients treated with appendectomy (odds ratio [OR], 0.52 [95% CI, 0.48-0.58]; P < .001), colectomy (OR, 0.58 [95% CI, 0.55-0.61]; P < .001), hysterectomy (OR, 0.44 [95% CI, 0.37-0.53]; P < .001), and radical prostatectomy (OR, 0.39 [95% CI, 0.25-0.61]; P < .001).CONCLUSIONS AND RELEVANCE: The proportion of patients developing SSIs within 30 days after surgery can be substantial and depends on the type of surgery. Minimally invasive surgery is significantly associated with reduced odds of SSIs. This advantage should be considered when assessing the overall benefits of minimally invasive techniques.
KW - Appendectomy
KW - Colectomy
KW - Female
KW - Humans
KW - Hysterectomy
KW - Male
KW - Minimally Invasive Surgical Procedures
KW - Propensity Score
KW - Prospective Studies
KW - Prostatectomy
KW - Quality Improvement
KW - Risk Factors
KW - Surgical Wound Infection
KW - United States
U2 - 10.1001/jamasurg.2014.292
DO - 10.1001/jamasurg.2014.292
M3 - SCORING: Journal article
C2 - 25143176
VL - 149
SP - 1039
EP - 1044
JO - JAMA SURG
JF - JAMA SURG
SN - 2168-6254
IS - 10
ER -