Methods: We analyzed data from 24 hospitals in the DICON surgical database in order to identify all patients who underwent colon (COLO) surgical procedures in 2015. ICD-9/ICD-10 procedure codes were used to determine whether these patients had open procedures or laparoscopic procedures. SSI was defined using NHSN definitions. Additional data collected on all patient undergoing colon surgery included the following: age; preoperative glucose level; ASA score; wound class; operation time. Large volume hospitals were defined as hospitals at which >100 COLO procedures were performed in 2015.
• A total 2307 COLO procedures were performed in 2015: 956(41.4%) procedures were done by laparoscopic approach and 1348 (58.6%) by open technique. A total of 73 SSIs occurred in the entire cohort (SSI rate=3.2%). The rate of SSI was lower in the laparoscopic group (n=25, 2.6%) compared to the open group (n=48, 3.6%), but this difference was not statistically significant (RR 0.82, 95%CI 0.60-1.13, p=0.20). The median operative times were similar between the two groups. However operative durations were longer in both groups among patients with SSI (laparoscopic group: 159 min vs 140 min, p=0.13; open group: 154 min vs 126 min, p<0.01). Organ/space SSIs (12/25, 48.0%) were common in laparoscopic group, while superficial incisional SSIs (23/48, 47.9%) were common in open group. The most common isolates from SSIs were E. coli in both laparoscopic and open group (24.0% and 18.8% respectively). Large volume hospitals had lower rates of SSI than small volume hospitals. The risk of SSI was 3.4-fold higher in small volume hospitals (RR=3.39, 95%CI 1.96-5.84, p<0.001).
Conclusion: Rates of SSI were similar in patients with laparoscopic COLO approach compared to open procedure. Of note, high volume hospitals had lower rates of SSI than small volume hospitals. Thus, hospitals looking to determine expected rate of SSI should account for surgical volume in their calculations.
R. W. Moehring, None
D. J. Sexton, None
D. Anderson, None