Henry P Schoonyoung, MD1, Andrew R Helber, AB1, Barath Krishnan, MD2, Gerald J Marks, MD1, John H Marks, MD1. 1Lankenau Medical Center, Marks Colorectal Surgical Associates, 2Lankenau Medical Center
Surgical site infection (SSI) is common after colorectal surgery. With superficial SSI rates ranging from 5–30%, we hypothesize that performing laparoscopic procedures using a strict clean and dirty technique further reduces the risk of SSI.
We analyzed all laparoscopic colorectal procedures performed on a prospectively maintained database for colorectal procedures retrospectively. 2067 patients were analyzed over a 20-year period from 2/1996-5/2016. Surgeries were performed using the clean and dirty technique. We defined superficial-SSI as an infection in the subcutaneous tissue without abscess, deep-SSI as an abdominal wall abscess, and organ space-SSI as an abdominal abscess, leak, or peritonitis. SSI rate with superficial, deep, and organ space, anastomotic leak, abscess, and fistula were analyzed by: age, sex, BMI, OR-time, preoperative radiation, transfusion, mortality, type of case(abdominal/pelvic), and LOS. Student’s t-test was performed.
49.8% were male. 24.1% received preoperative radiotherapy. 3% received transfusions. The conversion rate was 2.95%. Averages of the following were computed: age 61(16-95), BMI 27.1, EBL 189cc, OR-time 270min, LOS 5.8days, largest incision 4.9cm, follow-up 28.7mos.
SSI=4.69%(n=97), superficial-SSI=1.26%(n=26), deep-SSI=0.15%(n=3), organ space-SSI=3.67%(n=76), anastomotic leak=1.35%(n=28), and abdominal abscess/fistula=2.3%(n=48). There was a statistically significant difference in SSI for males, preoperative radiotherapy, increased EBL, increased OR-time, and LOS. There was no significant difference in perioperative mortality, age, BMI, transfusion rate, conversion rate, mortality, or type of case, abdominal/pelvic.
Laparoscopic colorectal surgery using a clean and dirty technique is associated with a much lower superficial-SSI rate compared to the literature in addition to lower overall SSI rate.
| n-SSI | %SSI | |
| SSI | 97 | 4.69 |
| Superficial-SSI | 26 | 1.26 |
| Deep-SSI | 3 | 0.15 |
| Organ Space-SSI | 76 | 3.67 |
| Anastomotic Leak | 28 | 1.35 |
| Abdominal Abscess/Fistula | 48 | 2.30 |
| n-Total | %Total | n-SSI | %SSI | p-value | |
| Sex(Female/Male) | 1038/1029 | 50.2/49.8 | 37/60 | 3.56/5.83 | 0.0149 |
| Preoperative Radiation(Y/N) | 498/1570 | 24.1/75.9 | 34/63 | 6.83/4.01 | 0.0298 |
| EBL(≤100/>100cc) | 1184/883 | 57.3/42.7 | 39/58 | 3.29/6.57 | 0.000868 |
|
OR Time(≤240/>240min) |
952/1115 | 46.1/53.9 | 27/70 | 2.84/6.28 |
0.000147 |
| Length of Stay(≤4/>4 days) | 1041/1026 | 50.4/49.6 |
23/74 |
2.21/7.21 | 0.00000131 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80356
Program Number: P183
Presentation Session: Poster (Non CME)
Presentation Type: Poster
