Surgical Site Infection Rates in Laparoscopic Versus Open Colorectal Surgery

2011 ◽  
Vol 77 (10) ◽  
pp. 1290-1294 ◽  
Author(s):  
Rahim Aimaq ◽  
Gabriel Akopian ◽  
Howard S. Kaufman
Keyword(s):  
Colorectal Surgery ◽  
Surgical Site Infections ◽  
Laparoscopic Group ◽  
Improvement Program ◽  
Chi Square ◽  
Factors Associated ◽  
Acs Nsqip ◽  
Increase Risk ◽  
Acs Nsqip Database ◽  
Wound Class

The purpose of this study was to use the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to evaluate the incidence of postoperative surgical site infections (SSIs) between laparoscopic (LAP) and open colorectal surgery. The 2008 ACS-NSQIP Participant Use File was queried by Current Procedural Terminology codes for colorectal surgery cases. SSI rates were compared between groups using Pearson chi-square and Fisher exact tests. Univariate and multivariate analyses were performed to identify factors associated with the LAP approach and/or SSIs. A total of 7,755 LAP and 16,184 open cases were identified. The laparoscopic group had an SSI rate of 9.4 versus 15.7 per cent for the open group ( P < 0.0001). There was no statistical difference in the type of SSI (superficial, deep, and/or organ space) between the two groups. Although multivariate analysis identified several factors associated with SSIs of different types, LAP was the only factor found to decrease risk, whereas wound class and operative time were found to increase risk among all categories of SSIs. Despite a significantly lower incidence of postoperative SSI, only 32 per cent of colorectal surgery was performed laparoscopically in NSQIP hospitals in 2008. Wider adoption of LAP approaches for colorectal surgery should continue to reduce SSIs.

scholarly journals Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery

Healthcare ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 85 ◽  
Author(s):  
Christopher G. Smith ◽  
Daniel L. Davenport ◽  
Justin Gorski ◽  
Anthony McDowell ◽  
Brian T. Burgess ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Improvement Program ◽  
Related Factors ◽  
Factors Associated ◽  
Acs Nsqip ◽  
Postoperative Blood Transfusion ◽  
Platinum Based Chemotherapy ◽  
Acs Nsqip Database

Background: Ovarian cancer (OC) is the leading cause of death from gynecologic malignancy and is treated with a combination of cytoreductive surgery and platinum-based chemotherapy. Extended length of stay (LOS) after surgery can affect patient morbidity, overall costs, and hospital resource utilization. The primary objective of this study was to identify factors contributing to prolonged LOS for women undergoing surgery for ovarian cancer. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify women from 2012–2016 who underwent hysterectomy for ovarian, fallopian tube and peritoneal cancer. The primary outcome was LOS >50th percentile. Preoperative and intraoperative variables were examined to determine which were associated with prolonged LOS. Results: From 2012–2016, 1771 women underwent elective abdominal surgery for OC and were entered in the ACS-NSQIP database. The mean and median LOS was 4.6 and 4.0 days (IQR 0–38), respectively. On multivariate analysis, factors associated with prolonged LOS included: American Society of Anesthesiologists (ASA) Classification III (aOR 1.71, 95% CI 1.38–2.13) or IV (aOR 1.88, 95% CI 1.44–2.46), presence of ascites (aOR 1.88, 95% CI 1.44–2.46), older age (aOR 1.23, 95% CI 1.13–1.35), platelet count >400,000/mm3 (aOR 1.74, 95% CI 1.29–2.35), preoperative blood transfusion (aOR 11.00, 95% CI 1.28–94.77), disseminated cancer (aOR 1.28, 95% CI 1.03–1.60), increased length of operation (121–180 min, aOR 1.47, 95% CI 1.13-1.91; >180 min, aOR 2.78, 95% CI 2.13–3.64), and postoperative blood transfusion within 72 h of incision (aOR 2.04, 95% CI 1.59–2.62) (p < 0.05 for all). Conclusions: Longer length of hospital stay following surgery for OC is associated with many patient, disease, and treatment-related factors. The extent of surgery, as evidenced by perioperative blood transfusion and length of surgical procedure, is a factor that can potentially be modified to shorten LOS, improve patient outcomes, and reduce hospital costs.

What Is the Relationship between Operative Time and Adverse Events after Colon and Rectal Surgery?

2018 ◽  
Vol 84 (5) ◽  
pp. 712-716 ◽  
Author(s):  
Gabriela Poles ◽  
Caitlin Stafford ◽  
Todd Francone ◽  
Patricia L. Roberts ◽  
Rocco Ricciardi
Keyword(s):  
Colorectal Surgery ◽  
Adverse Events ◽  
Operative Time ◽  
Primary Anastomosis ◽  
Multivariable Analysis ◽  
Rectal Surgery ◽  
Surgical Site Infections ◽  
Colon And Rectal Surgery ◽  
Improvement Program ◽  
Tract Infections

We propose that prolonged colorectal surgery operative times are associated with increased 30-day adverse events. We identified a cohort from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from January 2005 through December 2012. Patients who underwent colectomy with primary anastomosis were selected using CPT codes. Operative time was categorized into short, average, and long based on mean operative times 61 SD. NSQIP-approved multivariate models were used to identify associations between operative time and 30-day adverse events. A total of 113,615 patients underwent colorectal resection of which 46 per cent were laparoscopic and 12 per cent were identified as long operative times. Patients with long operative procedures had 34 per cent more superficial surgical site infections, 65 per cent more organ space infections, 69 per cent more abdominal dehiscences, 44 per cent more thrombotic complications, 45 per cent more urinary tract infections, 40 per cent more returns to the operating room, and 36 per cent more prolonged lengths of stay ( P < 0.05 for all analyses). The multivariable analysis revealed an association between long operative times and increased adverse events despite adjustment for all NSQIP recommended covariates. Our results reveal increased 30-day adverse events with increased operative time. We propose that operative time may serve as a proxy for surgical complexity in colorectal surgery.

scholarly journals Surgical Site Infections (SSI) and factors associated in a private tertiary care teaching hospital in Raichur, Karnataka, India

2018 ◽  
Vol 5 (8) ◽  
pp. 2899
Author(s):  
Prashanta Swami Pujar ◽  
K. B. Phuleker ◽  
Nagaraj Bhalki
Keyword(s):  
Risk Factors ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Research Centre ◽  
Chi Square ◽  
College Hospital ◽  
Factors Associated ◽  
Duration Of Surgery ◽  
Chi Square Test ◽  
A Prospective Study

Background: Prevention of Surgical site infection (SSI) remains a focus of attention because wound infections continue to be a major source of expense, morbidity, and even mortality. Three quarters of deaths of surgical patients with SSIs are attributed to nosocomial infections, nearly all of which are organ/space infections. The objective of the present study was to estimate the incidence of SSI and to study the various risk factors associated with SSI.Methods: This is a prospective study of 180 eligible cases eligible subjects, who underwent various surgeries in the department of General Surgery after applying inclusion and exclusion criteria. The study conducted at the Navodaya Medical College Hospital and Research Centre, Raichur. The tenure for the study was April 2017 to June 2017. Data was collected using pretested proforma. Data was analysed using SPSS version 16. Chi -square test and multiple logistic regression was applied to know the association between various risk factors and occurrence of SSI.Results: Among 180 patients 33 (18.33%) developed surgical site infections (SSI). Among 33 SSIs 25 (75.76%) were grade 3 and 8 (24.24%) were grade 4 infections. SSIs were found more commonly among patients over 50 years, diabetics, HIV infected patients, patients with longer duration of surgery and associations with these factors were found statistically significant.Conclusions: The incidence rate of SSI was quite high, and its end results will have a greater impact on patients as well as on healthcare systems. Prevention of SSI requires multipronged approach targeting both patient related and procedure related risk factors in pre- operative, intra-operative, and post-operative period.

scholarly journals Postoperative infection in foot & ankle surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0042
Author(s):  
Ashish Shah ◽  
Samuel Huntley ◽  
Eildar Abyar ◽  
Eva Lehtonen ◽  
Sameer Naranje ◽  
...  
Keyword(s):  
Surgical Site Infections ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Foot And Ankle ◽  
Improvement Program ◽  
Chi Square ◽  
Surgical Incision ◽  
Prosthetic Implants ◽  
Ankle Surgery ◽  
Orthopaedic Literature

Category: Other Introduction/Purpose: Surgical site infections (SSI) are infections of the incision site, organ, or space at or near the surgical incision within 30 days of the procedure or within 90 days for prosthetic implants. Being the most common nosocomial infection, SSI’s are a burden to the healthcare system as they increase costs, duration of stay, antimicrobial resistance, morbidity, and mortality. While there is limited evidence in the orthopaedic literature suggesting that the incidence of SSI increases during the summer months, this association has not been examined in the setting of foot and ankle surgery. The purpose of this study was to determine whether seasonal variation plays a role in developing SSI’s after orthopaedic foot and ankle surgery. Methods: Data from the National Surgical Quality Improvement Program (NSQIP) years 2011-2015 were used in this study. The pooled and individual incidences of superficial incisional SSI, deep SSI, and organ space SSI were calculated and stratified by quarter of admission. The quarters of admission represent the various seasons (1=winter, 2=spring, 3=summer, 4=fall). Differences in the incidence of SSI as well as various demographic, comorbidity, and complication variables were evaluated using ANOVA for continuous variables and Pearson’s Chi-Square for categorical variables. Results: A total of 17,939 patients were identified. After pooling the superficial, deep, and organ space infections, the overall SSI rate was highest in the summer months (July-September, 3rd quarter) at 2.68% as compared to 2.20%, 2.33%, and 2.14% in the other respective quarters (p=0.338). There was a total of 218 cases of superficial incisional SSI. The summer months had the highest incidence of superficial SSI at 1.38% compared to 1.14%, 1.13%, and 1.21% for 1st, 2nd, and 4th quarters, respectively (p=0.677). There were 145 cases of deep incisional SSI. The third quarter again had the highest rate at 1.02% compared to 0.72%, 0.93%, and 0.60% for 1st, 2nd, and 4th quarter respectively (p=0.105). Conclusion: Our results show that superficial incisional SSI, deep incisional SSI, and open wound infections have increased likelihood during the summer months in the setting of orthopaedic foot and ankle surgery. Some studies have associated the increased temperature and humidity during the summer months with increased rates of infections and our results show similar trends. Additional evidence with larger sample sizes is needed to determine which specific procedures are at highest risk of infection during the summer months.

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