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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 11/2016

01-11-2016 | Original Article

Differences in surgical site infection between laparoscopic colon and rectal surgeries: sub-analysis of a multicenter randomized controlled trial (Japan-Multinational Trial Organization PREV 07-01)

Authors: Saori Goto, Suguru Hasegawa, Hiroaki Hata, Takashi Yamaguchi, Koya Hida, Ryuta Nishitai, Satoshi Yamanokuchi, Akinari Nomura, Takeharu Yamanaka, Yoshiharu Sakai

Published in: International Journal of Colorectal Disease | Issue 11/2016

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Abstract

Background

The incidence of surgical site infection (SSI) is reportedly lower in laparoscopic colorectal surgery than in open surgery, but data on the difference in SSI incidence between colon and rectal laparoscopic surgeries are limited.

Methods

The incidence and risk factors for SSI, and the effect of oral antibiotics in colon and rectal laparoscopic surgeries, were investigated as a sub-analysis of the JMTO-PREV-07-01 (a multicenter, randomized, controlled trial of oral/parenteral vs. parenteral antibiotic prophylaxis in elective laparoscopic colorectal surgery).

Results

A total of 582 elective laparoscopic colorectal resections, comprising 376 colon surgeries and 206 rectal surgeries, were registered. The incidence of SSI in rectal surgery was significantly higher than in colon surgery (14 vs. 8.2 %, P = 0.041). Although the incidence of incisional SSI was almost identical (7 %) between the surgeries, the incidence of organ/space SSI in rectal surgery was significantly higher than in colon surgery (6.3 vs. 1.1 %, P = 0.0006). The lack of oral antibiotics was significantly associated with the development of SSI in colon surgery. Male sex, stage IV cancer, and abdominoperineal resection were significantly associated with SSI in rectal surgery. The combination of oral and parenteral antibiotics significantly reduced the overall incidence of SSI in colon surgery (relative risk 0.41, 95 % confidence interval 0.19–0.86).

Conclusion

The incidence of SSI in laparoscopic rectal surgery was higher than in colon surgery because of the higher incidence of organ/space SSI in rectal surgery. The risk factors for SSIs and the effect of oral antibiotics differed between these two procedures.
Literature
1.
Mangram AJ, Horan TC, Pearson ML, et al. (1999) Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 20:250–278CrossRefPubMed
2.
Magill SS, Hellinger W, Cohen J, et al. (2012) Prevalence of healthcare-associated infections in acute care hospitals in Jacksonville, Florida. Infect Control Hosp Epidemiol 33:283–291CrossRefPubMedPubMedCentral
3.
Zimlichman E, Henderson D, Tamir O, et al. (2013) Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 173:2039–2046CrossRefPubMed
4.
Al-Tawfiq JA, Tambyah PA (2014) Healthcare associated infections (HAI) perspectives. J Infect Public Health 7:339–344CrossRefPubMed
5.
Schweizer ML, Cullen JJ, Perencevich EN, Vaughan Sarrazin MS. Costs Associated With Surgical Site Infections in Veterans Affairs Hospitals. JAMA Surg 2014.
6.
Horan TC, Gaynes RP, Martone WJ, et al. (1992) CDC definitions of nosocomial surgical site infections, 1992—a modification of CDC definitions of surgical wound infections. Am J Infect Control 20:271–274CrossRefPubMed
7.
8.
Blumetti J, Luu M, Sarosi G, et al. (2007) Surgical site infections after colorectal surgery: do risk factors vary depending on the type of infection considered? Surgery 142:704–711CrossRefPubMed
9.
Morikane K, Honda H, Yamagishi T, et al. (2014) Factors associated with surgical site infection in colorectal surgery: the Japan nosocomial infections surveillance. Infect Control Hosp Epidemiol 35:660–666CrossRefPubMed
10.
Aimaq R, Akopian G, Kaufman HS (2011) Surgical site infection rates in laparoscopic versus open colorectal surgery. Am Surg 77:1290–1294PubMed
11.
Konishi T, Watanabe T, Kishimoto J, Nagawa H (2006) Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg United States:758–763
12.
Serra-Aracil X, Isabel Garcia-Domingo M, Pares D, et al. (2011) Surgical site infection in elective operations for colorectal cancer after the application of preventive measures. Arch Surg 146:606–612CrossRefPubMed
13.
Ruiz-Tovar J, Llavero C, Morales V, Gamallo C (2015) Total occlusive ionic silver-containing dressing vs mupirocin ointment application vs conventional dressing in elective colorectal surgery: effect on incisional surgical site infection. J Am Coll Surg 221:424–429CrossRefPubMed
14.
Hjalmarsson C, Karlberg J, Tornqvist P, et al. (2015) Orally administered trimethoprim-sulfamethoxazole and metronidazole as infection prophylaxis in elective colorectal surgery. Surg Infect 16:604–610CrossRef
15.
Kang CY, Halabi WJ, Luo R, et al. (2012) Laparoscopic colorectal surgery: a better look into the latest trends. Arch Surg 147:724–731CrossRefPubMed
16.
Yeo H, Niland J, Milne D, et al. (2015) Incidence of minimally invasive colorectal cancer surgery at National Comprehensive Cancer Network centers. J Natl Cancer Inst 107:362CrossRefPubMed
17.
Guillou PJ, Quirke P, Thorpe H, et al. (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726CrossRefPubMed
18.
Neudecker J, Klein F, Bittner R, et al. (2009) Short-term outcomes from a prospective randomized trial comparing laparoscopic and open surgery for colorectal cancer. Br J Surg 96:1458–1467CrossRefPubMed
19.
Kiran RP, El-Gazzaz GH, Vogel JD, Remzi FH. Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program. In J Am Coll Surg. United States: 2010 American College of Surgeons. Published by Elsevier Inc 2010 232–238.
20.
Poon JT, Law WL, Wong IW, et al. (2009) Impact of laparoscopic colorectal resection on surgical site infection. Ann Surg 249:77–81CrossRefPubMed
21.
Howard DPJ, Datta G, Cunnick G, et al. (2010) Surgical site infection rate is lower in laparoscopic than open colorectal surgery. Color Dis 12:423–427CrossRef
22.
Drosdeck J, Harzman A, Suzo A, et al. (2013) Multivariate analysis of risk factors for surgical site infection after laparoscopic colorectal surgery. Surgical Endoscopy and Other Interventional Techniques 27:4574–4580CrossRefPubMed
23.
Hata H, Yamaguchi T, Hasegawa S et al. Oral and parenteral versus parenteral antibiotic prophylaxis in elective laparoscopic colorectal surgery (JMTO PREV 07-01): a phase 3, multicenter, open-label, randomized trial. Ann Surg 2016.
24.
Wolff BG, Beart RW Jr, Dozois RR, et al. (1988) A new bowel preparation for elective colon and rectal surgery. A prospective, randomized clinical trial. Arch Surg 123:895–900CrossRefPubMed
25.
Culver DH, Horan TC, Gaynes RP, et al. (1991) Surgical wound-infection rates by wound class, operative procedure, and patient risk index. Am J Med 91:S152–S157CrossRef
26.
Degrate L, Garancini M, Misani M, et al. (2011) Right colon, left colon, and rectal surgeries are not similar for surgical site infection development. Analysis of 277 elective and urgent colorectal resections. Int J Color Dis 26:61–69CrossRef
27.
Lujan J, Valero G, Hernandez Q, et al. (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96:982–989CrossRefPubMed
28.
Aziz O, Constantinides V, Tekkis PP, et al. (2006) Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 13:413–424CrossRefPubMed
29.
Kawada K, Hasegawa S, Hida K, et al. (2014) Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis. Surg Endosc 28:2988–2995CrossRefPubMedPubMedCentral
30.
Biondo S, Kreisler E, Fraccalvieri D, et al. (2012) Risk factors for surgical site infection after elective resection for rectal cancer. A multivariate analysis on 2131 patients. Color Dis 14:e95–e102CrossRef
31.
Tang RP, Chen HH, Wang YL, et al. (2001) Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients. Ann Surg 234:181–189CrossRefPubMedPubMedCentral
32.
Cardo D, Horan T, Andrus M, et al. (2004) National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32:470–485CrossRef
33.
Kwaan MR, Melton GB, Madoff RD, Chipman JG (2015) Abdominoperineal resection, pelvic exenteration, and additional organ resection increase the risk of surgical site infection after elective colorectal surgery: an American College of Surgeons National Surgical Quality Improvement Program Analysis. Surg Infect 16:675–683CrossRef
34.
Musters GD, Buskens CJ, Bemelman WA, Tanis PJ (2014) Perineal wound healing after abdominoperineal resection for rectal cancer: a systematic review and meta-analysis. Dis Colon rectum 57:1129–1139CrossRefPubMed
35.
Kuroyanagi H, Oya M, Ueno M, et al. (2008) Standardized technique of laparoscopic intracorporeal rectal transection and anastomosis for low anterior resection. Surg Endosc 22:557–561CrossRefPubMed
36.
Qu H, Liu Y, Bi DS (2015) Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc 29:3608–3617CrossRefPubMed
37.
Bellows CF, Mills KT, Kelly TN, Gagliardi G (2011) Combination of oral non-absorbable and intravenous antibiotics versus intravenous antibiotics alone in the prevention of surgical site infections after colorectal surgery: a meta-analysis of randomized controlled trials. Techniques in Coloproctology 15:385–395CrossRefPubMed
38.
Nelson RL, Gladman E, Barbateskovic M. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database of Systematic Reviews 2014.
39.
Fielding LP, Stewartbrown S, Blesovsky L, Kearney G (1980) Anastomotic integrity after operations for large-bowel cancer—a multicenter study. Br Med J 281:411–414CrossRefPubMedPubMedCentral
40.
Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 334:1209–1215CrossRefPubMed
Metadata
Title
Differences in surgical site infection between laparoscopic colon and rectal surgeries: sub-analysis of a multicenter randomized controlled trial (Japan-Multinational Trial Organization PREV 07-01)
Authors
Saori Goto
Suguru Hasegawa
Hiroaki Hata
Takashi Yamaguchi
Koya Hida
Ryuta Nishitai
Satoshi Yamanokuchi
Akinari Nomura
Takeharu Yamanaka
Yoshiharu Sakai
Publication date
01-11-2016
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 11/2016
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-016-2643-1

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