Effect of Minimally Invasive Surgery on the Risk for Surgical Site Infections

TLDR

Surgical site infection is the second most common hospital‑acquired infection and the most frequent infection in surgical patients, yet data on how the surgical approach influences its risk are limited. This study aimed to assess the impact of open versus minimally invasive surgery on 30‑day SSI risk in a large contemporary cohort across multiple specialties. Using the ACS NSQIP database (2005‑2011), the authors identified patients undergoing appendectomy, colectomy, hysterectomy, or radical prostatectomy, abstracted 30‑day SSI outcomes, and compared open and MIS groups with propensity‑score matching followed by logistic regression. MIS was associated with markedly lower SSI rates and odds—3.8% vs 7.0% for appendectomy, 9.3% vs 15.0% for colectomy, 1.8% vs 3.9% for hysterectomy, and 1.0% vs 2.4% for prostatectomy—across all procedures, demonstrating a significant advantage that should inform surgical decision‑making.

Abstract

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.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.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).Thirty-day SSIs.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.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).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.