Study Shows Minimally Invasive Surgery Reduces Risk of HAIs Compared to Open Surgery

PHILADELPHIA -- Ethicon Endo-Surgery today announces results from a new study showing laparoscopic surgery reduced the risk of hospital-acquired infections (HAIs) by 52 percent when compared to open surgery in a sample of more than 11,000 patients undergoing one of the following three surgical procedures: hysterectomy, cholecystectomy and appendectomy. Specific to individual surgeries, the study found laparoscopic surgery was associated with reduction of the risk of nosocomial infections during gallbladder removal by 66 percent, and during hysterectomy by 52 percent compared to open surgery. The study showed the reduction rates of HAIs during laparoscopic appendectomy were not statistically significant.

The results of the study will be presented on April 12, 2008 at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) annual meeting. The data also will be published in the April edition of Surgical Endoscopy, the official journal of SAGES. 

The study, sponsored by Ethicon Endo-Surgery and titled "The Effects of Laparoscopic Cholecystectomy, Hysterectomy, and Appendectomy on Nosocomial Infection Risks," is the first to examine infections specific to these procedures 30 days post-discharge, providing a more comprehensive picture of infection patterns than previously available. The study discovered 40 percent of the infections identified occurred within 30 days after hospital discharge.

Results of the study also showed laparoscopic surgery was associated with a reduction in the overall odds ratio for each type of nosocomial infection. Compared to open surgery, patients in the study who underwent laparoscopic surgery experienced 80 percent reduction in the odds of respiratory tract infection, 69 percent reduction in bloodstream infection, 59 percent reduction in wound infection, 39 percent reduction in urinary tract infection and a 48 percent reduction in other types of nosocomial infections across hysterectomies, cholecystectomies and appendectomies.

In addition to the potential patient benefits due to reduced infection, there are cost implications of the study, as well. The study found that 27 percent of patients identified with a post-discharge infection were re-admitted to the hospital, which is an added cost for hospitals and payors. However, there was a 65 percent reduction in hospital readmissions for HAIs when a patient underwent laparoscopic gallbladder removal and hysterectomy when compared to open surgery.

"This study gives more definitive evidence that laparoscopic surgery reduces the risk of nosocomial infection compared to open surgery, which may lead to improved patient care and potential reductions in costs to the healthcare system, " said Andrew I. Brill, MD, director of minimally invasive gynecology at the California Pacific Medical Center in San Francisco.

The retrospective study covered more than 11,000 patients for the period September 1, 2004 through December 31, 2006 from 22 hospitals across 15 states that had undergone laparoscopic or open hysterectomy (43.3 percent of patients), gallbladder removal (32.7 percent of patients) and appendectomy (24 percent of patients). In the current study, 337 patients (2.89 percent) experienced at least one nosocomial infection. Overall, infection rates were nearly twice as high for open procedures (4.09 percent) than for laparoscopic procedures (2.11 percent). The study utilized the Nosocomial Infection Marker (NIM), an algorithm designed by Cardinal Health that monitors and tracks nosocomial infection rates for up to 30 days post-discharge. In a previous multi-hospital study, the NIM algorithm identified nosocomial infections with 86 percent sensitivity and 98.5 percent specificity, statistically outperforming CDC case-finding methods.(1)

"This study demonstrates the significant impact minimally-invasive technology can have on patient care and healthcare cost-saving," said Andrew Webber, president and CEO of National Business Coalition on Health, a non-profit, membership association of 60 business and health coalitions, representing a national network of 7,000 employers and 34 million covered lives. "As adoption rates for laparoscopic surgery continue to grow, both patients and the employers who pay for the bulk of healthcare may benefit from improved quality of care and reduced costs as patients could possibly realize shorter hospital stays and reduced potential complications."

Reference: Brossette SE, Hacek DM, Gavin PJ, et al. A laboratory-based, hospital-wide, electronic marker for nosocomial infections: the future of infection control surveillance? Am J Clin Pathol 2006; 125:34-39.

Source: Ethicon Endo-Surgery