Minimizing Risks in Minimally Invasive Surgery: Rates of Surgical Site Infection Across Subtypes of Laparoscopic Hysterectomy.

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  • Additional Information
    • Affiliation:
      Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois (all authors).
    • Abstract:
      Study Objective: To compare the 30-day incidence of deep or organ-space and/or superficial incisional surgical site infections (SSIs) by the subtype of laparoscopic hysterectomy and to report on additional risk factors for SSIs following laparoscopic hysterectomy.Design: Retrospective cohort study.Setting: American College of Surgeons National Surgical Quality Improvement Program Database.Patients: Women undergoing laparoscopic hysterectomy from 2012 to 2014.Interventions: Women were stratified into 3 groups by the type of hysterectomy: total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy (LAVH), and laparoscopic supracervical hysterectomy (LSCH). Demographic and clinical characteristics were compared for the 3 groups using the Kruskal-Wallis test or 1-way analysis of variance, where appropriate, for continuous variables and the chi-square or Fisher's exact test for categoric variables. Post hoc analyses were performed for multiple comparisons. Univariate analyses to examine the association with SSI were performed using the t test or Wilcoxon rank sum test as appropriate for continuous variables and the chi-square test or Fisher's exact test as appropriate for categoric variables. Significant variables on univariate analysis were included in a stepwise, backward multivariable logistic regression to identify the independent risk factors of SSI.Measurements and Main Results: In total, 46 755 women underwent laparoscopic hysterectomy. Most were classified as TLH (26 009, 56%), followed by LAVH (13 884, 30%), and LSCH (6862, 14%). The overall rate of 30-day deep or organ-space SSI was 1.8% (n = 445). Thirty-day deep or organ-space SSI was lower in women who underwent LSCH (0.6%) than in women who underwent TLH (1.0%) or LAVH (1.1%; p = .001), but there was no difference in the incidence of superficial incisional SSI (0.8%, 0.8%, and 0.8% for TLH, LAVH, and LSCH, respectively; p = .75). On multivariate regression analysis, LSCH remained independently associated with a decreased risk of deep or organ-space SSI (adjusted odds ratio, 0.60; 95% confidence interval, 0.43-0.84; p = .003). In addition, relative to the women who were discharged on the same day, women admitted for >24 hours had 2-fold increased odds of deep or organ-space SSI. Asian race, smoking, perioperative transfusion, dirty or infected cases, and American Society of Anesthesiologist class 3 were associated with increased odds for deep or organ-space SSI. Length of stay >24 hours and Native Hawaiian/Pacific Islander race were associated with increased odds of superficial incisional SSI.Conclusion: LSCH is associated with a decreased risk of deep or organ-space SSI compared with other subtypes of laparoscopic hysterectomy. Same-day discharge after laparoscopic hysterectomy is associated with decreased odds of SSI.
    • Journal Subset:
      Biomedical; Peer Reviewed; USA
    • ISSN:
      1553-4650
    • MEDLINE Info:
      PMID: NLM31672589 NLM UID: 101235322
    • Publication Date:
      In Process
    • Publication Date:
      20200926
    • DOI:
      10.1016/j.jmig.2019.10.015
    • Accession Number:
      145406421
  • Citations
    • ABNT:
      BROWN, O. et al. Minimizing Risks in Minimally Invasive Surgery: Rates of Surgical Site Infection Across Subtypes of Laparoscopic Hysterectomy. Journal of Minimally Invasive Gynecology, [s. l.], v. 27, n. 6, p. 1370, 2020. DOI 10.1016/j.jmig.2019.10.015. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=145406421. Acesso em: 29 out. 2020.
    • AMA:
      Brown O, Geynisman-Tan J, Gillingham A, et al. Minimizing Risks in Minimally Invasive Surgery: Rates of Surgical Site Infection Across Subtypes of Laparoscopic Hysterectomy. Journal of Minimally Invasive Gynecology. 2020;27(6):1370. doi:10.1016/j.jmig.2019.10.015
    • APA:
      Brown, O., Geynisman-Tan, J., Gillingham, A., Collins, S., Lewicky-Gaupp, C., Kenton, K., & Mueller, M. (2020). Minimizing Risks in Minimally Invasive Surgery: Rates of Surgical Site Infection Across Subtypes of Laparoscopic Hysterectomy. Journal of Minimally Invasive Gynecology, 27(6), 1370. https://doi.org/10.1016/j.jmig.2019.10.015
    • Chicago/Turabian: Author-Date:
      Brown, Oluwateniola, Julia Geynisman-Tan, Akira Gillingham, Sarah Collins, Christina Lewicky-Gaupp, Kimberly Kenton, and Margaret Mueller. 2020. “Minimizing Risks in Minimally Invasive Surgery: Rates of Surgical Site Infection Across Subtypes of Laparoscopic Hysterectomy.” Journal of Minimally Invasive Gynecology 27 (6): 1370. doi:10.1016/j.jmig.2019.10.015.
    • Harvard:
      Brown, O. et al. (2020) ‘Minimizing Risks in Minimally Invasive Surgery: Rates of Surgical Site Infection Across Subtypes of Laparoscopic Hysterectomy’, Journal of Minimally Invasive Gynecology, 27(6), p. 1370. doi: 10.1016/j.jmig.2019.10.015.
    • Harvard: Australian:
      Brown, O, Geynisman-Tan, J, Gillingham, A, Collins, S, Lewicky-Gaupp, C, Kenton, K & Mueller, M 2020, ‘Minimizing Risks in Minimally Invasive Surgery: Rates of Surgical Site Infection Across Subtypes of Laparoscopic Hysterectomy’, Journal of Minimally Invasive Gynecology, vol. 27, no. 6, p. 1370, viewed 29 October 2020, .
    • MLA:
      Brown, Oluwateniola, et al. “Minimizing Risks in Minimally Invasive Surgery: Rates of Surgical Site Infection Across Subtypes of Laparoscopic Hysterectomy.” Journal of Minimally Invasive Gynecology, vol. 27, no. 6, Sept. 2020, p. 1370. EBSCOhost, doi:10.1016/j.jmig.2019.10.015.
    • Chicago/Turabian: Humanities:
      Brown, Oluwateniola, Julia Geynisman-Tan, Akira Gillingham, Sarah Collins, Christina Lewicky-Gaupp, Kimberly Kenton, and Margaret Mueller. “Minimizing Risks in Minimally Invasive Surgery: Rates of Surgical Site Infection Across Subtypes of Laparoscopic Hysterectomy.” Journal of Minimally Invasive Gynecology 27, no. 6 (September 2020): 1370. doi:10.1016/j.jmig.2019.10.015.
    • Vancouver/ICMJE:
      Brown O, Geynisman-Tan J, Gillingham A, Collins S, Lewicky-Gaupp C, Kenton K, et al. Minimizing Risks in Minimally Invasive Surgery: Rates of Surgical Site Infection Across Subtypes of Laparoscopic Hysterectomy. Journal of Minimally Invasive Gynecology [Internet]. 2020 Sep [cited 2020 Oct 29];27(6):1370. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=145406421