Association between the proportion of laparoscopic approaches for digestive surgeries and the incidence of consequent surgical site infections, 2009-2019: A retrospective observational study based on national surveillance data in Japan

Toshiki Kajihara; Koji Yahara; Aki Hirabayashi; Yumiko Hosaka; Norikazu Kitamura; Motoyuki Sugai; Keigo Shibayama

doi:10.1371/journal.pone.0281838

Association between the proportion of laparoscopic approaches for digestive surgeries and the incidence of consequent surgical site infections, 2009-2019: A retrospective observational study based on national surveillance data in Japan

PLoS One. 2023 Feb 17;18(2):e0281838. doi: 10.1371/journal.pone.0281838. eCollection 2023.

Authors

Toshiki Kajihara¹, Koji Yahara¹, Aki Hirabayashi¹, Yumiko Hosaka¹, Norikazu Kitamura¹, Motoyuki Sugai¹, Keigo Shibayama²

Affiliations

¹ Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan.
² Department of Bacteriology/Drug Resistance and Pathogenesis, Nagoya University, Graduate School of Medicine, Showa-ku, Nagoya, Japan.

Abstract

Background: Surgical site infections (SSIs) are among the most common healthcare-associated infections. Laparoscopy is increasingly being used in various surgical procedures. However, no study has examined the association between the proportion of laparoscopic procedures and the incidence of SSIs in digestive surgery using nationwide surveillance data.

Methods: We retrospectively investigated national SSI surveillance data from the Japan Nosocomial Infections Surveillance between 2009 and 2019. The annual trend of the SSI rate and the proportion of laparoscopic procedures were assessed, focusing on five major digestive surgeries. This was based on data from 109,544 (appendix surgery), 206,459 (gallbladder surgery), 60,225 (small bowel surgery), 363,677 (colon surgery), and 134,695 (rectal surgery) procedures. The effect of a 10% increase in the proportion of laparoscopic procedures on the reduction of the SSI rate was estimated using mixed-effect logistic regression.

Findings: The average SSI rate of the five digestive surgeries decreased from 11.8% in 2009 to 8.1% in 2019. The proportion of laparoscopic procedures in each of the five digestive surgeries increased continuously (p<0.001). The SSI rate for laparoscopic procedures was always lower than that for open procedures. The results were consistent between all and core hospitals participating in the surveillance. The odds ratios of the 10% increase in the proportion of laparoscopic procedures for five digestive surgeries were always <0.950 (p<0.001).

Conclusion: An increase in the proportion of laparoscopic procedures was associated with a reduction in the SSI rate in digestive surgeries.

Copyright: © 2023 Kajihara et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Cross Infection* / epidemiology
Humans
Incidence
Japan / epidemiology
Laparoscopy* / adverse effects
Retrospective Studies
Risk Factors
Surgical Wound Infection / etiology

Grants and funding

This study was supported by the Research Program on Emerging and Re-emerging Infectious Diseases from the Japan Agency for Medical Research and Development (AMED) under grant number JP21fk0108604. Funding acquisition: K. S. and M. S. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.