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Incidence of Surgical Site Infection Associated with Robotic Surgery

Published online by Cambridge University Press:  02 January 2015

Elizabeth D. Hermsen ,
Tim Hinze ,
Harlan Sayles ,
Lee Sholtz  and
Mark E. Rupp
Elizabeth D. Hermsen*
Affiliation:
Pharmacy Relations and Clinical Decision Support, Nebraska Medical Center, Omaha, Nebraska Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska Section of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Tim Hinze
Affiliation:
Department of Pharmaceutical and Nutrition Care, Nebraska Medical Center, Omaha, Nebraska
Harlan Sayles
Affiliation:
Biostatistics Department, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
Lee Sholtz
Affiliation:
Department of Healthcare Epidemiology and Infection Control, Nebraska Medical Center, Omaha, Nebraska
Mark E. Rupp
Affiliation:
Section of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
*
BCPS-ID 984031, Nebraska Medical Center, Omaha, NE 68198-4031 (ehermsen@nebraskamed.com)
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Abstract

Objective.

Robot-assisted surgery is minimally invasive and associated with less blood loss and shorter recovery time than open surgery. We aimed to determine the duration of robot-assisted surgical procedures and the incidence of postoperative surgical site infection (SSI) and to compare our data with the SSI incidence for open procedures according to national data.

Design.

Retrospective cohort study.

Setting.

A 689-bed academic medical center.

Patients.

All patients who underwent a surgical procedure with use of a robotic surgical system during the period from 2000-2007.

Methods.

SSIs were defined and procedure types were classified according to National Healthcare Safety Network criteria. National data for comparison were from 1992-2004. Because of small sample size, procedures were grouped according to surgical site or wound classification.

Results.

Sixteen SSIs developed after 273 robot-assisted procedures (5.9%). The mean surgical duration was 333.6 minutes. Patients who developed SSI had longer mean surgical duration than did patients who did not (558 vs 318 minutes; P<.001). The prostate and genitourinary group had 5.74 SSIs per 100 robot-assisted procedures (95% confidence interval [CI], 2.81–11.37), compared with 0.85 SSIs per 100 open procedures from national data. The gynecologic group had 10.00 SSIs per 100 procedures (95% CI, 2.79–30.10), compared with 1.72 SSIs per 100 open procedures. The colon and herniorrhaphy groups had 33.33 SSIs per 100 procedures (95% CI, 9.68–70.00) and 37.50 SSIs per 100 procedures (95% CI, 13.68–69.43), respectively, compared with 5.88 and 1.62 SSIs per 100 open procedures from national data. Patients with a clean-contaminated wound developed 6.1 SSIs per 100 procedures (95% CI, 3.5–10.3), compared with 2.59 SSIs per 100 open procedures. No significant differences in SSI rates were found for other groups.

Conclusions.

Increased incidence of SSI after some types of robot-assisted surgery compared with traditional open surgery may be related to the learning curve associated with use of the robot.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 8 , August 2010 , pp. 822 - 827
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Perencevich, EN, Sands, KE, Cosgrove, SE, Guadagnoli, E, Meara, E, Piatt, R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003;9:196–203.Google Scholar
2.Brill, A, Ghosh, K, Gunnarsson, C, et al.The effects of laparoscopic cholecystectomy, hysterectomy, and appendectomy on nosocomial infection risks. Surg Endosc 2008;22:1112–1118.Google Scholar
3.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20:250–280.Google Scholar
4.Talamini, MA, Chapman, S, Horgan, S, Melvin, WS. A prospective analysis of 211 robotic-assisted surgical procedures. Surg Endosc 2003;17:1521–1524.CrossRefGoogle ScholarPubMed
5.Corcione, F, Esposito, C, Cuccurullo, D, et al.Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc 2005;19:117–119.Google Scholar
6.Braumann, C, Jacobi, CA, Menenakos, C, Ismail, M, Rueckert, JC, Mueller, JM. Robotic-assisted laparoscopic and thoracoscopic surgery with the da Vinci system: a 4-year experience in a single institution. Surg Laparosc Endosc Percutan Tech 2008;18:260–266.Google Scholar
7.Cardo, D, Horan, T, Andrus, M, et al.National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
8.The National Healthcare Safety Network (NHSN) Manual: Patient Safety Component Protocol. National Healthcare Safety Network Web site. http://www.cdc.gov/nhsn/TOC_PSCManual.html. Published April 2010. Accessed June 11, 2010.Google Scholar
9.Hermsen, ED, Smith Shull, S, Puumala, SE, Rupp, ME. Improvement in prescribing habits and economic outcomes associated with the introduction of a standardized approach for surgical antimicrobial prophylaxis. Infect Control Hosp Epidemiol 2008;29:457–461.Google Scholar
10.Geller, EJ, Siddiqui, NY, Wu, JM, Visco, AG. Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol 2008;112:1201–1206.CrossRefGoogle ScholarPubMed
11.Morino, M, Pellegrino, L, Giaccone, C, Garrone, C, Rebecchi, F. Randomized clinical trial of robot-assisted versus laparoscopic Nissen fundopli-cation. Br J Surg 2006;93:553–558.Google Scholar
12.Eden, CG, Neill, MG, Louie-Johnsun, MW. The first 1000 cases of laparoscopic radical prostatectomy in the UK: evidence of multiple “learning curves.” BJU Int 2009;103:1224–1230.Google Scholar
13.Patel, VR, Tufty, AS, Holmes, R, Lindsay, J. Robotic radical prostatectomy in the community setting—the learning curve and beyond: initial 200 cases. J Urol 2005;174:269–272.Google Scholar
14.Bell, MC, Torgerson, JL, Kreaden, U. The first 100 da Vinci hysterectomies: an analysis of the learning curve for a single surgeon. S D Med 2009;62: 91, 93–95.Google Scholar
15.Pitter, MC, Anderson, P, Blissett, A, Pemberton, N. Robotic-assisted gynaecological surgery—establishing training criteria; minimizing operative time and blood loss. Int J Med Robot 2008;4:114–120.Google Scholar
16.Turner, WF Jr, Sloan, JH. Robotic-assisted coronary artery bypass on a beating heart: initial experience and implications for the future. Ann Thorac Surg 2006;82:790–794.Google Scholar
17.Rupp, ME, Sholtz, L, Craig, R, Oleynikov, D, Marion, N. Surgical Site Infections Associated with Robotic Surgery. Paper presented at: 15th annual meeting of the Society for Healthcare Epidemiology of America; April 2005; Los Angeles, CA.Google Scholar