Balancing the risk of postoperative surgical infections: a multivariate analysis of factors associated with
Fergal J Fleming1, Michael J Kim, Susan Messing
1Division of Colorectal Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Objective:
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.
Background:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
Insights
Laparoscopic appendectomy reduces incisional surgical site infections but increases organ space infection (OSI) risk compared to open surgery. This risk varies by patient profile, influencing operative approach decisions.
Area of Science:
- Surgical outcomes research
- Infectious disease epidemiology
- Minimally invasive surgery
Background:
- Laparoscopic appendectomy generally shows lower incisional infection rates than open surgery.
- The impact of laparoscopic versus open appendectomy on organ space infection (OSI) requires further clarification.
Purpose of the Study:
- To determine the association between operative approach (laparoscopic vs. open) and surgical site infections (incisional and organ space) after appendectomy.
- To adjust for confounding factors in assessing the relationship between surgical approach and infection risk.
Main Methods:
- Analysis of appendectomy cases (2005-2008) from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.
- Logistic regression models were employed to identify factors associated with surgical infections and calculate OSI probabilities.
- Patient factors and operative variables were recorded to assess outcomes.
Main Results:
- Laparoscopy (77% of 39,950 cases) was linked to significantly lower incisional infection risk (OR 0.37).
- Multivariate analysis revealed laparoscopy was associated with a higher risk of organ space infection (OSI) (OR 1.44).
- OSI risk for high-risk patients was 8.9% open vs. 12.3% laparoscopic, while low-risk patients had 0.3% vs. 0.4%.
Conclusions:
- Laparoscopic appendectomy is associated with reduced incisional infection but increased organ space infection (OSI) risk.
- The magnitude of increased OSI risk with laparoscopy is dependent on individual patient clinical profiles.
- Understanding these differential risks can guide surgeons in selecting the optimal operative approach for appendectomy.
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