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Tserenpuntsag B, Haley V, Ann Hazamy P, Eramo A, Knab R, Tsivitis M, Clement EJ. Risk factors for surgical site infection after abdominal hysterectomy, New York State, 2015-2018. Am J Infect Control 2023; 51:539-543. [PMID: 37003562 DOI: 10.1016/j.ajic.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE To identify risk factors for surgical site infections (SSIs) after abdominal hysterectomy (HYST) procedures using National Healthcare Safety Network (NHSN) data augmented with diagnosis codes available using administrative data. METHODS We analyzed 66,001 HYST procedures in 166 New York State hospitals between January 2015 and December 2018, reported in NHSN, and matched to billing data. Risks factors for SSI after abdominal hysterectomy were identified using logistic regression models. RESULTS A total of 66,001 HYST procedures were analyzed. SSI was reported following 1,093 procedures, resulting in an infection rate of 1.66%. Risk factors associated with SSIs were open approach (not laparoscopic) with an adjusted odds ratio (AOR) of 2.72 and 95% confidence interval (CI) of 2.37-3.12, contaminated or dirty wound class (AOR 2.28, 95% CI 1.61-3.24), body mass index ≥30 (AOR 1.78, 95% CI 1.56-2.02), procedures lasting 186 minutes or more (AOR 1.78, 95% CI 1.56-2.02), American Society of Anesthesia (ASA) score ≥3 (AOR 1.74, 95% CI 1.52-1.99), gynecological cancer (AOR 1.54, 95% CI 1.32-1.80), and diabetes mellitus (AOR 1.46, 95% CI 1.24-1.70). CONCLUSION Obesity, prolonged procedure duration, diabetes mellitus, wound contamination, open approach, ASA score ≥3, and gynecological cancer were significant independent risk factors associated with SSI after hysterectomy.
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Affiliation(s)
| | - Valerie Haley
- New York State Hospital Acquired Infection Reporting Program, New York State Department of Health
| | - Peggy Ann Hazamy
- New York State Hospital Acquired Infection Reporting Program, New York State Department of Health
| | - Antonella Eramo
- New York State Hospital Acquired Infection Reporting Program, New York State Department of Health
| | - Robin Knab
- New York State Hospital Acquired Infection Reporting Program, New York State Department of Health
| | - Marie Tsivitis
- New York State Hospital Acquired Infection Reporting Program, New York State Department of Health
| | - Ernest J Clement
- Bureau of Healthcare Associated Infections, New York State Department of Health
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2
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Bianchini S, Rigotti E, Monaco S, Nicoletti L, Auriti C, Castagnola E, Conti G, Galli L, Giuffrè M, La Grutta S, Lancella L, Lo Vecchio A, Maglietta G, Petrosillo N, Pietrasanta C, Principi N, Tesoro S, Venturini E, Piacentini G, Lima M, Staiano A, Esposito S. Surgical Antimicrobial Prophylaxis in Abdominal Surgery for Neonates and Paediatrics: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:279. [PMID: 35203881 PMCID: PMC8868062 DOI: 10.3390/antibiotics11020279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 01/26/2023] Open
Abstract
Surgical site infections (SSIs), i.e., surgery-related infections that occur within 30 days after surgery without an implant and within one year if an implant is placed, complicate surgical procedures in up to 10% of cases, but an underestimation of the data is possible since about 50% of SSIs occur after the hospital discharge. Gastrointestinal surgical procedures are among the surgical procedures with the highest risk of SSIs, especially when colon surgery is considered. Data that were collected from children seem to indicate that the risk of SSIs can be higher than in adults. This consensus document describes the use of preoperative antibiotic prophylaxis in neonates and children that are undergoing abdominal surgery and has the purpose of providing guidance to healthcare professionals who take care of children to avoid unnecessary and dangerous use of antibiotics in these patients. The following surgical procedures were analyzed: (1) gastrointestinal endoscopy; (2) abdominal surgery with a laparoscopic or laparotomy approach; (3) small bowel surgery; (4) appendectomy; (5) abdominal wall defect correction interventions; (6) ileo-colic perforation; (7) colorectal procedures; (8) biliary tract procedures; and (9) surgery on the liver or pancreas. Thanks to the multidisciplinary contribution of experts belonging to the most important Italian scientific societies that take care of neonates and children, this document presents an invaluable reference tool for perioperative antibiotic prophylaxis in the paediatric and neonatal populations.
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Affiliation(s)
- Sonia Bianchini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Erika Rigotti
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (G.P.)
| | - Sara Monaco
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Laura Nicoletti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Cinzia Auriti
- Neonatology and Neonatal Intensive Care Unit, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Giannina Gaslini, 16147 Genoa, Italy;
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy;
| | - Luisa Galli
- Pediatric Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Mario Giuffrè
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90141 Palermo, Italy;
| | - Stefania La Grutta
- Institute for Biomedical Research and Innovation, National Research Council, 90146 Palermo, Italy;
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, Via D. Montesano 49, 80131 Naples, Italy; (A.L.V.); (A.S.)
| | - Giuseppe Maglietta
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy;
| | | | - Carlo Pietrasanta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Mother, Child and Infant, NICU, 20122 Milan, Italy;
| | | | - Simonetta Tesoro
- Division of Anesthesia, Analgesia and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, 06129 Perugia, Italy;
| | - Elisabetta Venturini
- Pediatric Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (G.P.)
| | - Mario Lima
- Paediatric Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, Via D. Montesano 49, 80131 Naples, Italy; (A.L.V.); (A.S.)
| | - Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
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Wang L, Yang F, Zhang S, Li C, Du Z, Rycus P, Tonna JE, Alexander P, Lorusso R, Fan E, Ogino M, Brodie D, Combes A, Chen YS, Qiu H, Peng Z, Fraser JF, Shao J, Jia M, Wang H, Hou X. Percutaneous versus surgical cannulation for femoro-femoral VA-ECMO in patients with cardiogenic shock: results from the Extracorporeal Life Support Organization Registry. J Heart Lung Transplant 2022; 41:470-481. [DOI: 10.1016/j.healun.2022.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/24/2021] [Accepted: 01/03/2022] [Indexed: 12/18/2022] Open
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Ali KM, Al-Jaff BM. Source and antibiotic susceptibility of gram-negative bacteria causing superficial incisional surgical site infections. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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5
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Day Care Appendectomy Is Safe in Young Patients with Uncomplicated Early Presentation. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02309-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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6
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Hajong R, Dhal MR, Newme K, Moirangthem T, Boruah MP. A cross sectional study of risk factors for surgical site infections after laparoscopic and open cholecystectomy in a tertiary care hospital in North East India. J Family Med Prim Care 2021; 10:339-342. [PMID: 34017750 PMCID: PMC8132748 DOI: 10.4103/jfmpc.jfmpc_1245_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/13/2020] [Accepted: 12/02/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Surgical site infection (SSI) after cholecystectomy unduly delays patients' early return to normal activities and also leaves behind relatively disfigured cosmetic scars at the port sites. This prospective study was undertaken to assess the various risk factors leading to SSI in patients undergoing cholecystectomy, both by laparoscopic and open techniques in this part of India for which no data is available at present. Material and Methods: A total of 1507 cholecystectomies (1184 by laparoscopy and 323 by open technique) during a 6 year period. The various risk factors studied were gender, age, BMI, DM, chronic anaemia, COPD, timing of surgery (elective or emergent), influence of surgeon (operated by resident surgeon or faculty), intraoperative bile spillage, etc., Odd's ratio was calculated to see the influence of the factors on SSI and statistical significance was tested by Chi-square test. Results: The overall rate of infection was 3.12% (1.94% in laparoscopy and 7.43% in the open technique). Intraoperative bile spillage, increasing age, increased duration of surgery, laparoscopic cholecystectomy done by resident surgeons, increased intraoperative blood loss, emergent operations done for acute cholecystitis, etc., were associated with higher rates of SSI. Conclusion: Meticulous operative techniques avoiding bile spillage and blood loss during cholecystectomy may reduce the chances of developing SSI.
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Affiliation(s)
- Ranendra Hajong
- Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
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Thomas V, Maillard C, Barnard A, Snyman L, Chrysostomou A, Shimange-Matsose L, Van Herendael B. International Society for Gynecologic Endoscopy (ISGE) guidelines and recommendations on gynecological endoscopy during the evolutionary phases of the SARS-CoV-2 pandemic. Eur J Obstet Gynecol Reprod Biol 2020; 253:133-140. [PMID: 32866856 PMCID: PMC7448735 DOI: 10.1016/j.ejogrb.2020.08.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised some important interrogations on minimally invasive gynaecological surgery. The International Society for Gynecologic Endoscopy (ISGE) has taken upon itself the task of providing guidance and best practice policies for all practicing gynaecological endoscopists. Factors affecting decision making processes in minimal invasive surgery (MIS) vary depending on factors such as the phase of the pandemic, policies on control and prevention, expertise and existing infrastructure. Our responsibility remains ensuring the safety of all health care providers, ancillary staff and patients during this unusual period. We reviewed the current literature related to gynecological and endoscopic surgery during the Coronavirus Disease 19 (COVID-19) crisis. Regarding elective surgery, universal testing for SARS-CoV-2 infection should be carried out wherever possible 40 h prior to surgery. In case of confirmed positive case of SARS-CoV-2, surgery should be delayed. Priority should be given to relatively urgent cases such as malignancies. ISGE supports medical optimization and delaying surgery for benign non-life-threatening surgeries. When possible, we recommend to perform cases by laparoscopy and to allow early discharges. Any procedure with risk of bowel involvement should be performed by open surgery as studies have found a high amount of viral RNA (ribonucleic acid) in stool. Regarding urgent surgery, each unit should create a risk assessment flow chart based on capacity. Patients should be screened for symptoms and symptomatic patients must be tested. In the event that a confirmed case of SARS-CoV-2 is found, every attempt should be made to optimize medical management and defer surgery until the patient has recovered and only emergency or life-threatening surgery should be performed in these cases. We recommend to avoid intubation and ventilation in SARS-CoV-2 positive patients and if at all possible local or regional anesthesia should be utilized. Patients who screen or test negative may have general anesthesia and laparoscopic surgery while strict protocols of infection control are upheld. Surgery in screen-positive as well as SARS-CoV-2 positive patients that cannot be safely postponed should be undertaken with full PPE with ensuring that only essential personnel are exposed. If available, negative pressure theatres should be used for patients who are positive or screen high risk. During open and vaginal procedures, suction can be used to minimize droplet and bioaerosol spread. In a patient who screens low risk or tests negative, although carrier and false negatives cannot be excluded, laparoscopy should be strongly considered. We recommend, during minimal access surgeries, to use strategies to reduce production of bioaerosols (such as minimal use of energy, experienced surgeon), to reduce leakage of smoke aerosols (for example, minimizing the number of ports used and size of incisions, as well as reducing the operating pressures) and to promote safe elimination of smoke during surgery and during the ports' closure (such as using gas filters and smoke evacuation systems). During the post-peak period of pandemic, debriefing and mental health screening for staff is recommended. Psychological support should be provided as needed. In conclusion, based on the existent evidence, ISGE largely supports the current international trends favoring laparoscopy over laparotomy on a case by case risk evaluation basis, recognizing the different levels of skill and access to minimally invasive procedures across various countries.
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Affiliation(s)
- Viju Thomas
- Department of Obstetrics and Gynecology, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
| | - Charlotte Maillard
- Department of Obstetrics and Gynecology, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa; Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), 1200 Brussels, Belgium.
| | - Annelize Barnard
- Department of Obstetrics and Gynecology, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
| | - Leon Snyman
- Department of Obstetrics and Gynecology, Kalafong Tertiary Hospital, University of Pretoria, Pretoria, South Africa
| | - Andreas Chrysostomou
- Department of Obstetrics and Gynecology, Charlotte Maxeke Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Lusandolwethu Shimange-Matsose
- Department of Obstetrics and Gynecology, Charlotte Maxeke Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Bruno Van Herendael
- Stuivenberg General Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium,Università degli Studi dell’Insubria, Varese, Italy
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8
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Stancu B, Grad NO, Mihaileanu VF, Chiorescu S, Pintea SD, Constantinescu MI. Surgical technique of concomitant laparoscopically assisted vaginal hysterectomy and laparoscopic cholecystectomy. Med Pharm Rep 2017; 90:348-352. [PMID: 28781532 PMCID: PMC5536215 DOI: 10.15386/cjmed-747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/23/2017] [Accepted: 05/22/2017] [Indexed: 12/22/2022] Open
Abstract
Background Laparoscopically assisted vaginal hysterectomy is one of the most frequently performed gynecologic operations, and numerous authors have demonstrated its safety and feasibility. Case presentation We practiced in some selected cases simultaneous laparoscopically assisted vaginal total hysterectomy with bilateral adnexectomy and laparoscopic cholecystectomy using 5 trocars without uterine manipulator. Previous examinations included abdominal ultrasound, cervix biopsy and CT of abdomen and pelvis. Our aim was to evaluate the surgical technique of our initial experiences for combined laparoscopically assisted vaginal hysterectomy and laparoscopic colecystectomy. Conclusions Laparoscopic hysterectomy had a number of advantages over the conventional technique given the underlying associated diseases, postoperative pain, rapid recovery and aesthetic benefits.
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Affiliation(s)
- Bogdan Stancu
- 2 Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nicolae Ovidiu Grad
- 2 Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Stefan Chiorescu
- 2 Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Daniela Pintea
- 2 Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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9
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Hassinger TE, Guidry CA, Rotstein OD, Duane TM, Evans HL, Cook CH, O'Neill PJ, Mazuski JE, Askari R, Napolitano LM, Namias N, Miller PR, Dellinger EP, Coimbra R, Cocanour CS, Banton KL, Cuschieri J, Popovsky K, Sawyer RG. Longer-Duration Antimicrobial Therapy Does Not Prevent Treatment Failure in High-Risk Patients with Complicated Intra-Abdominal Infections. Surg Infect (Larchmt) 2017. [PMID: 28650745 DOI: 10.1089/sur.2017.084] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Recent studies have suggested the length of treatment of intra-abdominal infections (IAIs) can be shortened without detrimental effects on patient outcomes. However, data from high-risk patient populations are lacking. We hypothesized that patients at high risk for treatment failure will benefit from a longer course of antimicrobial therapy. METHODS Patients enrolled in the Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial were evaluated retrospectively to identify risk factors associated with treatment failure, which was defined as the composite outcome of recurrent IAI, surgical site infection, or death. Variables were considered risk factors if there was a positive statistical association with treatment failure. Patients were then stratified according to the presence and number of these risk factors. Univariable analyses were performed using the Kruskal-Wallis, χ2, and Fisher exact tests. Logistic regression controlling for risk factors and original randomization group, either a fixed four-day antimicrobial regimen (experimental) or a longer course based on clinical response (control), also was performed. RESULTS We identified corticosteroid use, Acute Physiology and Chronic Health Evaluation II score ≥5, hospital-acquired infection, or a colonic source of IAI as risk factors associated with treatment failure. Of the 517 patients enrolled, 263 (50.9%) had one or two risk factors and 16 (3.1%) had three or four risk factors. The rate of treatment failure rose as the number of risk factors increased. When controlling for randomization group, the presence and number of risk factors were independently associated with treatment failure, but the duration of antimicrobial therapy was not. CONCLUSIONS We were able to identify patients at high risk for treatment failure in the STOP-IT trial. Such patients did not benefit from a longer course of antibiotic administration. Further study is needed to determine the optimum duration of antimicrobial therapy in high-risk patients.
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Affiliation(s)
- Taryn E Hassinger
- 1 Department of Surgery, The University of Virginia Health System , Charlottesville, Virginia
| | - Christopher A Guidry
- 1 Department of Surgery, The University of Virginia Health System , Charlottesville, Virginia
| | - Ori D Rotstein
- 2 Department of Surgery, University of Toronto , Toronto, Ontario, Canada
| | - Therese M Duane
- 3 Department of Surgery, University of North Texas John Peter Smith Hospital , Fort Worth, Texas
| | - Heather L Evans
- 4 Department of Surgery, University of Washington , Seattle, Washington
| | - Charles H Cook
- 5 Department of Surgery, Beth Israel Deaconess Medical Center , Boston, Massachusetts
| | | | - John E Mazuski
- 7 Department of Surgery, Washington University , St. Louis, Missouri
| | - Reza Askari
- 8 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts
| | - Lena M Napolitano
- 9 Department of Surgery, University of Michigan , Ann Arbor, Michigan
| | - Nicholas Namias
- 10 Department of Surgery, University of Miami Miller School of Medicine , Miami, Florida
| | - Preston R Miller
- 11 Department of Surgery, Wake Forest School of Medicine , Winston-Salem, North Carolina
| | | | - Raul Coimbra
- 12 Department of Surgery, University of California , San Diego, San Diego, California
| | - Christine S Cocanour
- 13 Department of Surgery, University of California Davis Medical Center , Sacramento, California
| | - Kaysie L Banton
- 14 Department of Surgery, University of Minnesota Medical School , Minneapolis, Minnesota
| | - Joseph Cuschieri
- 4 Department of Surgery, University of Washington , Seattle, Washington
| | - Kimberley Popovsky
- 1 Department of Surgery, The University of Virginia Health System , Charlottesville, Virginia
| | - Robert G Sawyer
- 1 Department of Surgery, The University of Virginia Health System , Charlottesville, Virginia
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10
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Woelber E, Schrick EJ, Gessner BD, Evans HL. Proportion of Surgical Site Infections Occurring after Hospital Discharge: A Systematic Review. Surg Infect (Larchmt) 2016; 17:510-9. [DOI: 10.1089/sur.2015.241] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Erik Woelber
- University of Washington School of Medicine, Seattle, Washington
| | - Emily J. Schrick
- University of Washington College of Arts and Sciences, Seattle, Washington
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11
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Sasmal PK, Mishra TS, Rath S, Meher S, Mohapatra D. Port site infection in laparoscopic surgery: A review of its management. World J Clin Cases 2015; 3:864-871. [PMID: 26488021 PMCID: PMC4607803 DOI: 10.12998/wjcc.v3.i10.864] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/08/2015] [Accepted: 07/27/2015] [Indexed: 02/05/2023] Open
Abstract
Laparoscopic surgery (LS), also termed minimal access surgery, has brought a paradigm shift in the approach to modern surgical care. Early postoperative recovery, less pain, improved aesthesis and early return to work have led to its popularity both amongst surgeons and patients. Its application has progressed from cholecystectomies and appendectomies to various other fields including gastrointestinal surgery, urology, gynecology and oncosurgery. However, LS has its own package of complications. Port site infection (PSI), although infrequent, is one of the bothersome complications which undermine the benefits of minimal invasive surgery. Not only does it add to the morbidity of the patient but also spoils the reputation of the surgeon. Despite the advances in the field of antimicrobial agents, sterilization techniques, surgical techniques, operating room ventilation, PSIs still prevail. The emergence of rapid growing atypical mycobacteria with multidrug resistance, which are the causative organism in most of the cases, has further compounded the problem. PSIs are preventable if appropriate measures are taken preoperatively, intraoperatively and postoperatively. PSIs can often be treated non-surgically, with early identification and appropriate management. Macrolides, quinolones and aminoglycosides antibiotics do show promising activity against the atypical mycobacteria. This review article highlights the clinical burden, presentations and management of PSIs in LS as shared by various authors in the literature. We have given emphasis to atypical mycobacteria, which are emerging as a common etiological agent for PSIs in LS. Although the existing literature lacks consensus regarding PSI management, the complication can be best avoided by strictly abiding by the commandments of sterilization techniques of the laparoscopic instruments with appropriate sterilizing agent.
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12
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Xiao Y, Shi G, Zhang J, Cao JG, Liu LJ, Chen TH, Li ZZ, Wang H, Zhang H, Lin ZF, Lu JH, Yang T. Surgical site infection after laparoscopic and open appendectomy: a multicenter large consecutive cohort study. Surg Endosc 2014; 29:1384-93. [PMID: 25303904 DOI: 10.1007/s00464-014-3809-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 08/11/2014] [Indexed: 12/31/2022]
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13
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Roy S, Patkar A, Daskiran M, Levine R, Hinoul P, Nigam S. Clinical and Economic Burden of Surgical Site Infection in Hysterectomy. Surg Infect (Larchmt) 2014; 15:266-73. [DOI: 10.1089/sur.2012.163] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Sanjoy Roy
- Health Economics and Outcomes Research, Johnson & Johnson Global Surgery Group, Somerville, New Jersey
| | - Anuprita Patkar
- Health Economics and Outcomes Research, Johnson & Johnson Global Surgery Group, Somerville, New Jersey
| | - Mehmet Daskiran
- Healthcare Informatics, Medical Devices & Diagnostics, Johnson & Johnson, Inc., New Brunswick, New Jersey
| | - Ronald Levine
- Healthcare Informatics, Medical Devices & Diagnostics, Johnson & Johnson, Inc., New Brunswick, New Jersey
| | - Piet Hinoul
- Medical Affairs, Johnson & Johnson Global Surgery Group, Somerville, New Jersey
| | - Somesh Nigam
- Independence Blue Cross, Philadelphia, Pennsylvania
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14
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Goolab BD. Vaginal hysterectomy and relative merits over abdominal and laparoscopically assisted hysterectomy. Best Pract Res Clin Obstet Gynaecol 2013; 27:393-413. [DOI: 10.1016/j.bpobgyn.2013.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 01/31/2013] [Indexed: 10/26/2022]
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15
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O'Hanlan KA, McCutcheon SP, McCutcheon JG, Charvonia BE. Quality improvement: single-field sterile scrub, prep, and dwell for laparoscopic hysterectomy. AORN J 2013; 97:539-46. [PMID: 23622826 DOI: 10.1016/j.aorn.2013.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 01/18/2012] [Accepted: 03/12/2013] [Indexed: 11/16/2022]
Abstract
The vulva and vaginal interior are considered a contaminated surgical area, and current OR guidelines require surgeons who are gloved and gowned at the abdominal field to avoid contact with the urethral catheter, the uterine manipulator, and the introitus or to change their gloves and even regown if contact occurs. It is our belief that the perception of the vaginal field as contaminated reflects a lack of specific standards for the preoperative cleansing of the deeper vagina and a lack of preoperative prep instructions for the combined fields. We developed a comprehensive single-field prep technique designed to improve surgical efficiency and prevent contamination of the sterile field. Combining a methodical scrub, prep, and dwell, this technique allows the entire abdomino-perineovaginal field to be treated as a single sterile field for laparoscopic procedures. Our surgical site infection rate of 1.8% when using this single-field prep technique and the subsequent surgical treatment of the abdominal, vaginal, and perineal fields as a single sterile field is well within reported norms.
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73-156. [PMID: 23461695 DOI: 10.1089/sur.2013.9999] [Citation(s) in RCA: 698] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
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Infección de la herida quirúrgica. Efectividad de los apósitos con polihexametileno biguanida. ENFERMERIA CLINICA 2013; 23:56-61. [DOI: 10.1016/j.enfcli.2013.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 01/13/2013] [Accepted: 01/29/2013] [Indexed: 12/12/2022]
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283. [DOI: 10.2146/ajhp120568] [Citation(s) in RCA: 1364] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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19
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Colon MJ, Kitamura R, Telem DA, Nguyen S, Divino CM. Laparoscopic umbilical hernia repair is the preferred approach in obese patients. Am J Surg 2012; 205:231-6. [PMID: 23153398 DOI: 10.1016/j.amjsurg.2012.02.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 01/06/2012] [Accepted: 02/01/2012] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The optimal method of umbilical hernia repair (UHR) in the obese population, laparoscopic vs open, is not standardized. The purpose of this study was to determine the optimal surgical option for UHR in the obese population. METHODS A retrospective chart review was conducted on 123 obese patients (body mass index [BMI] >30) who underwent UHR from 2003 to 2009 at a single institution. Patients were grouped by surgical approach (open vs laparoscopic). Intraoperative and postoperative courses were compared. Follow-up in the postoperative period was obtained from patient records and telephone interviews. RESULTS Of the 123 patients undergoing UHR, 40 and 83 patients were operated on with the laparoscopic and open approach, respectively. Patients were well matched by demographics as well as comorbidities. No difference in the mean BMI was shown between the laparoscopic and open groups (37 vs 35, P = not significant, respectively). The operative time was significantly prolonged in the laparoscopic group (106 vs 71 minutes, P < .01). Intraoperatively, no complications occurred in either group. In the immediate postoperative period, 1 patient who underwent laparoscopic UHR was readmitted for small bowel obstruction, and 2 patients in the open group were readmitted, 1 for pain control and 1 for wound infection. Follow-up was achieved in 63% of the laparoscopic group and 58% of the open group with a mean follow-up of 15 months in the laparoscopic group and 20 months in the open group (P = not significant). A significant increase in wound infection was reported in the open group with mesh insertion when compared with the laparoscopic procedure (26% vs 4%, P < .05, respectively). No hernia recurrence was shown in the laparoscopic vs the open group with mesh insertion (0% vs 4%, P = not significant, respectively). CONCLUSIONS In obese patients, the laparoscopic approach was associated with a significantly lower rate of postoperative infection and no hernia recurrence. Laparoscopic hernia repair may be the preferred option in the obese patient.
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Affiliation(s)
- Modesto J Colon
- Department of Surgery, Division of General Surgery, The Mount Sinai Hospital, New York, NY, USA
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20
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Paat-Ahi G, Swiderek M, Sakowski P, Saluse J, Aaviksoo A. DRGs in Europe: a cross country analysis for cholecystectomy. HEALTH ECONOMICS 2012; 21 Suppl 2:66-76. [PMID: 22815113 DOI: 10.1002/hec.2833] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cholecystectomy is the surgical removal of the gallbladder. It is the most common method for treating symptomatic gallstones. Despite the existence of well-established treatment guidelines, the rate of cholecystectomy varies widely across Europe. We analyse patients in 10 countries that had undergone surgery for the treatment of symptomatic gallstones. We test the performance of three models in explaining variation in the (log of) cost of the inpatient stay (seven countries) or length of stay (three countries). The first model includes only the diagnosis-related group (DRG) variables to which cholecystectomy patients were coded (M(D)), the second uses a core set of patient characteristics and episode-specific explanatory variables (M(P)), and finally, the third model combines both sets of variables (M(F)). Countries vary both in the number of DRGs used to classify cholecystectomy patients (range: 2-8), and in the percentage of patients covered by a single DRG (range: 50%-92%). The ability of combining both DRGs and patient level variables to explain cost variation among patients ranges from 58% in Spain to over 81% in Finland. The comparison of models' performance suggests that incorporating relevant patient characteristics may significantly improve DRG systems.
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O'Hanlan KA, McCutcheon SP, McCutcheon JG, Charvonia BE. Single-field sterile-scrub, preparation, and dwell for laparoscopic hysterectomy. J Minim Invasive Gynecol 2012; 19:220-4. [PMID: 22239998 DOI: 10.1016/j.jmig.2011.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 11/27/2011] [Accepted: 12/01/2011] [Indexed: 11/28/2022]
Abstract
Type VII laparoscopic hysterectomy is classified as a "clean-contaminated" procedure because the surgery involves contact with both the abdominal and vaginal fields. Because the vulva has traditionally been perceived as a separate but contaminated field, operating room guidelines have evolved to require that surgeons gloved and gowned at the abdominal field either avoid contact with the urethral catheter, the uterine manipulator, and the introitus or change their gloves and even re-gown after any contact with those fields. In the belief that the perception of the vaginal field as contaminated stems from inadequate preoperative preparation instructions, we have developed a rigorous abdomino-perineo-vaginal field preparation technique to improve surgical efficiency and prevent surgical site infections. This thorough scrub, preparation, and dwell technique enables the entire abdomino-perineo-vaginal field to be safely treated as a single sterile field while maintaining a low rate of surgical site infection, and should be further investigated in randomized studies.
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22
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[Pediatric appendicitis : Open or laparoscopic appendicectomy in a specialized visceral surgical clinic?]. Chirurg 2011; 82:1008-13. [PMID: 21431962 DOI: 10.1007/s00104-011-2087-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Following the first description of open appendicectomy using a lateral incision in the right lower abdomen by McBurney in 1894, this intervention was considered to be the standard method for treatment of appendicitis for nearly 100 years. In 1983 the gynecologist Semm presented a new option for the surgical therapy of appendicitis with the implementation of laparoscopic appendicectomy. Since then the indications for laparoscopic therapy have developed from young adults through elderly patients to children, pregnant women and finally to infants and newborns.
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Page AJ, Pollock JD, Perez S, Davis SS, Lin E, Sweeney JF. Laparoscopic versus open appendectomy: an analysis of outcomes in 17,199 patients using ACS/NSQIP. J Gastrointest Surg 2010; 14:1955-62. [PMID: 20721634 DOI: 10.1007/s11605-010-1300-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 08/05/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND The current study was undertaken to evaluate the outcomes for open and laparoscopic appendectomy using the 2008 American College of Surgeons: National Surgical Quality Improvement Program (ACS/NSQIP) Participant Use File (PUF). We hypothesized that laparoscopic appendectomy would have fewer infectious complications, superior perioperative outcomes, and decreased morbidity and mortality when compared to open appendectomy. STUDY DESIGN Using the Current Procedural Technology (CPT) codes for open (44950) and laparoscopic (44970) appendectomy, 17, 199 patients were identified from the ACS/NSQIP PUF file that underwent appendectomy in 2008. Univariate analysis with chi-squared tests for categorical data and t tests or ANOVA tests for continuous data was used. Binary logistic regression models were used to evaluate outcomes for independent association by multivariable analysis. RESULTS Of the patients, 3,025 underwent open appendectomy and 14,174 underwent laparoscopic appendectomy. Patients undergoing laparoscopic appendectomy had significantly shorter operative times and hospital length of stay. They also had a significantly lower incidence of superficial and deep surgical site infections, wound disruptions, fewer complications, and lower perioperative mortality when compared to patients undergoing open appendectomy. CONCLUSIONS Using the ACS/NSQIP PUF file, we demonstrate that laparoscopic appendectomy has better outcomes than open appendectomy for the treatment of appendicitis. While the operative treatment of appendicitis is surgeon specific, this study lends support to the laparoscopic approach for patients requiring appendectomy.
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Affiliation(s)
- Andrew J Page
- Emory Endosurgery Unit, Division of General and Gastrointestinal Surgery, 1364 Clifton Rd NE, Suite H-124, Atlanta, GA 30322, USA
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Hermsen ED, Hinze T, Sayles H, Sholtz L, Rupp ME. Incidence of surgical site infection associated with robotic surgery. Infect Control Hosp Epidemiol 2010; 31:822-7. [PMID: 20586655 DOI: 10.1086/654006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Robot-assisted surgery is minimally invasive and associated with less blood loss and shorter recovery time than open surgery. We aimed to determine the duration of robot-assisted surgical procedures and the incidence of postoperative surgical site infection (SSI) and to compare our data with the SSI incidence for open procedures according to national data. DESIGN Retrospective cohort study. SETTING A 689-bed academic medical center. PATIENTS All patients who underwent a surgical procedure with use of a robotic surgical system during the period from 2000-2007. METHODS SSIs were defined and procedure types were classified according to National Healthcare Safety Network criteria. National data for comparison were from 1992-2004. Because of small sample size, procedures were grouped according to surgical site or wound classification. RESULTS Sixteen SSIs developed after 273 robot-assisted procedures (5.9%). The mean surgical duration was 333.6 minutes. Patients who developed SSI had longer mean surgical duration than did patients who did not (558 vs 318 minutes; P<.001). The prostate and genitourinary group had 5.74 SSIs per 100 robot-assisted procedures (95% confidence interval [CI], 2.81-11.37), compared with 0.85 SSIs per 100 open procedures from national data. The gynecologic group had 10.00 SSIs per 100 procedures (95% CI, 2.79-30.10), compared with 1.72 SSIs per 100 open procedures. The colon and herniorrhaphy groups had 33.33 SSIs per 100 procedures (95% CI, 9.68-70.00) and 37.50 SSIs per 100 procedures (95% CI, 13.68-69.43), respectively, compared with 5.88 and 1.62 SSIs per 100 open procedures from national data. Patients with a clean-contaminated wound developed 6.1 SSIs per 100 procedures (95% CI, 3.5-10.3), compared with 2.59 SSIs per 100 open procedures. No significant differences in SSI rates were found for other groups. CONCLUSIONS Increased incidence of SSI after some types of robot-assisted surgery compared with traditional open surgery may be related to the learning curve associated with use of the robot.
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Affiliation(s)
- Elizabeth D Hermsen
- Pharmacy Relations and Clinical Decision Support, the Department of Pharmaceutical and Nutrition Care, Nebraska Medical Center, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 68198-4031, USA.
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Gunnarsson C, Rizzo JA, Hochheiser L. The effects of laparoscopic surgery and nosocomial infections on the cost of care: evidence from three common surgical procedures. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:47-54. [PMID: 18657101 DOI: 10.1111/j.1524-4733.2008.00422.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To examine the cost of care for laparoscopic versus open surgery and the added cost of nosocomial infections for three common surgical procedures: cholecystectomy, hysterectomy, and appendectomy. METHODS The Cardinal Health database repository was utilized to extract reimbursement data for laparoscopic and open cholecystectomy, hysterectomy, and appendectomy surgical procedures. Utilizing a 22-hospital sample and a Health Insurance Portability and Accountability Act compliant clinical data extraction technique, the Cardinal Health database repository produced a Nosocomial Infection Marker to identify and track nosocomial infection rates for these procedures. ICD-9 codes were utilized to identify 10,731 patients who had undergone these procedures between September 2004 and December 2006. Multivariable linear regression models were estimated to isolate the effects of laparoscopic versus open surgery and nosocomial infections on the cost of care. RESULTS Laparoscopic surgery significantly reduces the overall cost of care for cholecystectomies, hysterectomies, and appendectomies. Controlling for the cost of nosocomial infection, incremental cost savings from laparoscopic versus open surgery for all three procedures average $1608. Cholecystectomy has the largest savings ($3299), followed by hysterectomy ($1385) and appendectomy ($1032). These cost savings in part reflect that patients undergoing laparoscopic procedures have shorter lengths of stay. In contrast, nosocomial infection increases costs substantially for each surgery type, raising costs for cholecystectomy by $4794, hysterectomy by $4528, and appendectomy by $6108. CONCLUSION The cost of care for laparoscopic surgery is lower than open surgery for cholecystectomy, hysterectomy, and appendectomy. This conclusion is based on actual hospital reimbursement data.
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