Increasing rates of laparoscopic gastrointestinal surgery and decreasing rates of surgical site infections: an observational study in Japan from 2012\u20132017

Tomoko Takahashi,Hiroshi Nishiura

doi:10.1186/s12893-021-01373-2

Tomoko Takahashi, Hiroshi Nishiura

Open Access

https://doi.org/10.1186/s12893-021-01373-2

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Abstract

BackgroundSurgical site infections (SSI) are the most common healthcare-associated infection, and gastrointestinal surgery is frequently followed by a high incidence of SSI. Epidemiological analysis of the temporal trends in SSI following gastrointestinal surgery has yet to be performed in Japan. Our purpose was to descriptively investigate these trends.MethodsExtracting national surveillance data from the Japan Nosocomial Infections Surveillance (JANIS) system, we analyzed the frequency of SSI events following gastrointestinal surgery, which consisted of seven surgical procedures, from 2012–2017. We calculated the standardized infection ratio to compute risk-adjusted SSI frequency, and used the trend test to detect time-dependent changes.ResultsThe frequency of SSI events, except for those associated with surgery of the upper gastrointestinal tract, revealed a decreasing time-dependent trend. The use of laparoscopic surgery increased dramatically over time (p < 0.01 for the six applicable surgical sites), while the frequency of SSI events during laparoscopic surgery remained unchanged.ConclusionsThe increasing use of laparoscopic surgery was identified, and the observation coincided with the decreasing trend in SSI, especially in lower gastrointestinal tract surgery. If the relationship is causal, the overall SSI incidence among previously healthy individuals is expected to decrease, because the use of laparoscopic surgery has large growth potential in Japan.

Highlights

Surgical site infections (SSI) are the most common healthcare-associated infection, and gastrointestinal surgery is frequently followed by a high incidence of surgical site infections (SSI)
Because numerous risk factors have been investigated using individual-based datasets and addressing potential confounders [13, 14], the present study focused on the trend analysis, limited to adjusting for confounders only when calculating the standardized risk of infection
The number of registered medical institutes in the Japan Nosocomial Infections Surveillance (JANIS) SSI division and the total number of operations per medical institute are shown in Fig. 1 by type of surgery

Summary

Introduction

Surgical site infections (SSI) are the most common healthcare-associated infection, and gastrointestinal surgery is frequently followed by a high incidence of SSI. Risk factors other than patientrelated factors have been analyzed, namely, ileostomy or colostomy placement, emergency operation, and multiple colonic procedures [14] Despite these previous studies [11, 11,12,13,14,15], no epidemiological studies have been performed in Japan to investigate the time trends in SSI incidence (or alternatively, trends in the standardized infection ratio or relative risk of specific risk factors) following gastrointestinal surgery, or to explore the mechanisms underlying the trends, as have been performed elsewhere [16]. Understanding the time trends for SSI incidence may help determine important features or risk factors regulating the risk of SSI for specific surgical sites, and may be critical in evaluating past countermeasures and considering possible future actions

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