Balancing the Risk of Postoperative Surgical Infections
- 1 December 2010
- journal article
- Published by Wolters Kluwer Health in Annals of Surgery
- Vol. 252 (6), 895-900
- https://doi.org/10.1097/sla.0b013e3181f194fe
Abstract
To establish the relationship between operative approach (laparoscopic or open) and subsequent surgical infection (both incisional and organ space infection) postappendectomy, independent of potential confounding factors. Although laparoscopic appendectomy has been associated with lower rates of incisional infections than an open approach, the relationship between laparoscopy and organ space infection (OSI) is not as clearly established. Cases of appendectomy were retrieved from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for 2005 to 2008. Patient factors, operative variables, and the primary outcomes of incisional infections and OSIs were recorded. Factors associated with surgical infections were identified using logistic regression models. These models were then used to calculate probabilities of OSI in clinical vignettes demonstrating varying levels of infectious risk. A total of 39,950 appendectomy cases were included of which 30,575 (77%) were performed laparoscopically. On multivariate analysis, laparoscopy was associated with a lower risk of incisional infection [odds ratio (OR) 0.37, 95% confidence interval (CI) 0.32-0.43] but with an increased risk of OSI after adjustment for confounding factors (OR 1.44, 95% CI 1.21-1.73). For a low-risk patient, probability of OSI was calculated to be 0.3% and 0.4%, respectively, for open versus laparoscopic appendectomy, whereas for a high-risk patient, probabilities were estimated at 8.9% and 12.3%, respectively. Laparoscopy was associated with a decreased risk of incisional infection but with an increased risk of OSI. The degree of this increased risk varies depending on the clinical profile of a surgical patient. Recognition of these differences in risk may aid clinicians in the choice of operative approach for appendectomy.Keywords
This publication has 13 references indexed in Scilit:
- Laparoscopic Appendectomy—Is it Worth the Cost? Trend Analysis in the US from 2000 to 2005Journal of the American College of Surgeons, 2009
- Laparoscope Use and Surgical Site Infections in Digestive SurgeryAnnals of Surgery, 2008
- Choice of Approach for Appendicectomy: A Meta-analysis of Open Versus Laparoscopic AppendicectomySurgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2007
- Disconnect Between Incidence of Nonperforated and Perforated AppendicitisAnnals of Surgery, 2007
- Morbidity of laparoscopic surgery for complicated appendicitis: an international studySurgical Endoscopy, 2006
- The NSQIP: A new frontier in surgerySurgery, 2005
- Trends in utilization and outcomes of laparoscopic versus open appendectomyThe American Journal of Surgery, 2004
- The Burden of Appendicitis-Related Hospitalizations in the United States in 1997Surgical Infections, 2004
- Laparoscopic Versus Open AppendectomyAnnals of Surgery, 2004
- CDC definitions of nosocomial surgical site infections, 1992: A modification of CDC definitions of surgical wound infectionsAmerican Journal of Infection Control, 1992