Effect of Minimally Invasive Surgery on the Risk for Surgical Site Infections: Results From the National Surgical Quality Improvement Program (NSQIP) Database | Minimally Invasive Surgery | JAMA Surgery | JAMA Network
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Original Investigation
October 2014

Effect of Minimally Invasive Surgery on the Risk for Surgical Site Infections: Results From the National Surgical Quality Improvement Program (NSQIP) Database

Author Affiliations
  • 1Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
  • 2Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
  • 3Department of Urology, University of Michigan, Ann Arbor
  • 4Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
  • 5Dana-Farber Cancer Institute, Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Surg. 2014;149(10):1039-1044. doi:10.1001/jamasurg.2014.292

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.