• 1.

    Chen AYDaley JPappas TN, et al. Growing use of laparoscopic cholecystectomy in the national veterans affairs surgical risk study. Ann Surg 1998; 227:1224.

    • Search Google Scholar
    • Export Citation
  • 2.

    Te Velde EABax NMATytgat SH, et al. Minimally invasive pediatric surgery: increasing implementation in daily practice and resident's training. Surg Endosc 2008; 22:163166.

    • Search Google Scholar
    • Export Citation
  • 3.

    Hendolin HIPaakonen MEAlhava EM, et al. Laparoscopic or open cholecystectomy: a prospective randomized trial to compare postoperative pain, pulmonary function and stress response. Eur J Surg 2000; 166:394399.

    • Search Google Scholar
    • Export Citation
  • 4.

    Richards CEdwards JCulver D, et al. Does using a laparoscopic approach to cholecystectomy decrease the risk of surgical site infection? Ann Surg 2003; 237:358362.

    • Search Google Scholar
    • Export Citation
  • 5.

    Yagmurlu AVernon ABarnhart DC, et al. Laparoscopic appendectomy for perforated appendicitis: a comparison with open appendectomy. Surg Endosc 2006; 20:10511054.

    • Search Google Scholar
    • Export Citation
  • 6.

    Sekhar NTorquati AYoussef T, et al. A comparison of 399 open and 568 laparoscopic gastric bypasses performed during a 4-year period. Surg Endosc 2007; 21:665668.

    • Search Google Scholar
    • Export Citation
  • 7.

    Pokala NSadhasivam SKiran RP, et al. Complicated appendicitis—is the laparoscopic approach appropriate? A comparative study with the open approach: outcome in a community hospital setting. Am Surg 2007; 73:737742.

    • Search Google Scholar
    • Export Citation
  • 8.

    Imai EUeda MKanao K, et al. Surgical site infection risk factors identified by multivariate analysis for patient undergoing laparoscopic, open colon and gastric surgery. Am J Infect Control 2008; 36:727731.

    • Search Google Scholar
    • Export Citation
  • 9.

    Nakamura TOnozato WMitomi H, et al. Analysis of the risk factors for wound infection after surgical treatment of colorectal cancer: a matched case control study. Hepatogastroenterology 2009; 56:13161320.

    • Search Google Scholar
    • Export Citation
  • 10.

    Esteban Varela JWilson SENguyen NT. Laparoscopic surgery significantly reduces surgical-site infections compared with open surgery. Surg Endosc 2010; 24:270276.

    • Search Google Scholar
    • Export Citation
  • 11.

    Walsh PJRemedios AMFerguson JF, et al. Thoracoscopic versus open partial pericardectomy in dogs: comparison of postoperative pain and morbidity. Vet Surg 1999; 28:472479.

    • Search Google Scholar
    • Export Citation
  • 12.

    Devitt CMCox REHailey JJ. Duration, complications, stress and pain of open ovariohysterectomy versus a simple method of laparoscopic-assisted ovariohysterectomy in dogs. J Am Vet Med Assoc 2005; 227:921927.

    • Search Google Scholar
    • Export Citation
  • 13.

    Mayhew PDBrown DC. Prospective evaluation of two intra-corporeally sutured prophylactic laparoscopic gastropexy techniques compared with laparoscopic-assisted gastropexy in dogs. Vet Surg 2009; 38:738746.

    • Search Google Scholar
    • Export Citation
  • 14.

    Culp WTNMayhew PDBrown DC. The effect of laparoscopic versus open ovariectomy on postsurgical activity in small dogs. Vet Surg 2009; 38:811817.

    • Search Google Scholar
    • Export Citation
  • 15.

    Vasseur PBLevy JDown E, et al. Surgical wound infection rates in dogs and cats. Data from a teaching hospital. Vet Surg 1988; 17:6064.

    • Search Google Scholar
    • Export Citation
  • 16.

    Brown DCConzemius MGShofer F, et al. Epidemiologic evaluation of postoperative wound infections in dogs and cats. J Am Vet Med Assoc 1997; 210:13021306.

    • Search Google Scholar
    • Export Citation
  • 17.

    Heldman EBrown DCShofer E. The association of propofol usage with postoperative wound infection rate in clean wounds: a retrospective study. Vet Surg 1999; 28:256259.

    • Search Google Scholar
    • Export Citation
  • 18.

    Beal MWBrown DCShofer FS. The effects of perioperative hypothermia and the duration of anesthesia on post-operative wound infection rate in clean wounds: a retrospective study. Vet Surg 2000; 29:123127.

    • Search Google Scholar
    • Export Citation
  • 19.

    Nicholson MBeal MShofer F, et al. Epidemiologic evaluation of postoperative wound infection in clean-contaminated wounds: a retrospective study of 239 dogs and cats. Vet Surg 2002; 31:577581.

    • Search Google Scholar
    • Export Citation
  • 20.

    Howard JMBarker WFCulbertson WR, et al. Post-operative wound infections: the influence of ultraviolet irradiation of the operating room and various other factors. Ann Surg 1964;160(suppl 2):1192.

    • Search Google Scholar
    • Export Citation
  • 21.

    Biscione FMCouto RCPedrosa TM, et al. Comparison of the risk of surgical site infection after laparoscopic cholecystectomy and open cholecystectomy. Infect Control Hosp Epidemiol 2007; 28:11031106.

    • Search Google Scholar
    • Export Citation
  • 22.

    Chen LFAnderson DJHartwig MG, et al. Surgical site infections after laparoscopic and open cholecystectomies in community hospitals. Infect Control Hosp Epidemiol 2008; 29:9293.

    • Search Google Scholar
    • Export Citation
  • 23.

    Winslow ERBrunt LM. Perioperative outcomes of laparoscopic versus open splenectomy: a meta-analysis with an emphasis on complications. Surgery 2003; 134:647655.

    • Search Google Scholar
    • Export Citation
  • 24.

    Eugster SSchawalder PGaschen F, et al. A prospective study of post-operative surgical site infections in dogs and cats. Vet Surg 2004; 33:542550.

    • Search Google Scholar
    • Export Citation
  • 25.

    Wendelburg K. Surgical wound infection. In: Bojrab MJSmeak DDBloomberg MS, eds. Disease mechanisms in small animal surgery. 2nd ed. Philadelphia: Lippincott, Williams & Wilkins, 1993;5465.

    • Search Google Scholar
    • Export Citation
  • 26.

    Raahave DFriis-Moller ABjerre-Jepsen K, et al. The infective dose of aerobic and anaerobic bacteria in post-operative wound sepsis. Arch Surg 1986; 121:924929.

    • Search Google Scholar
    • Export Citation
  • 27.

    Cruse PJNFoord R. The epidemiology of wound infection: a ten year prospective study of 62,939 wounds. Surg Clin North Am 1980; 66:2740.

    • Search Google Scholar
    • Export Citation
  • 28.

    Montgomery JSJohnston WKWolf JS. Wound complications after hand-assisted laparoscopic surgery. J Urol 2005; 174:22262230.

  • 29.

    Stone HH. Prophylactic measures for wound infection. In: Varco RLDelaney JP, eds. Controversy in surgery. Philadelphia: WB Saunders Co, 1976;667.

    • Search Google Scholar
    • Export Citation
  • 30.

    Wu FPKHoekman KSietses C, et al. Systemic and peritoneal angiogenic response after laparoscopic or conventional colon resection in cancer patients: a prospective, randomized trial. Dis Colon Rectum 2004; 47:16701674.

    • Search Google Scholar
    • Export Citation
  • 31.

    Hopf HWHunt TKWest JM, et al. Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg 1997; 132:9971004.

    • Search Google Scholar
    • Export Citation
  • 32.

    Fleischmann EKugener AKabon B, et al. Laparoscopic surgery impairs tissue oxygen tension more than open surgery. Br J Surg 2007; 94:362368.

    • Search Google Scholar
    • Export Citation
  • 33.

    Sido BTeklote JRHartel M, et al. Inflammatory response after abdominal surgery. Best Pract Res Clin Anaesthesiol 2004; 18:439454.

  • 34.

    Targarona EMBalague CKnook MM, et al. Laparoscopic surgery and surgical infection. Br J Surg 2000; 87:536544.

  • 35.

    Yahara NAbe TMorita K, et al. Comparison of interleukin-6, interleukin-8 and granulocyte colony-stimulating factor production by the peritoneum in laparoscopic and open surgery. Surg Endosc 2002; 16:16151619.

    • Search Google Scholar
    • Export Citation
  • 36.

    Ure BMNiewold TABax NMA, et al. Peritoneal, systemic, and distant organ inflammatory responses are reduced by a laparoscopic approach and carbon dioxide versus air. Surg Endosc 2002; 16:836842.

    • Search Google Scholar
    • Export Citation
  • 37.

    Wu FPKSietses Cvon Blomberg BME, et al. Systemic and peritoneal inflammatory response after laparoscopic or conventional colon resection in cancer patients. Dis Colon Rectum 2003; 46:147155.

    • Search Google Scholar
    • Export Citation
  • 38.

    Watson RWRedmond HPMcCarthy J, et al. Exposure of the peritoneal cavity to air regulates early inflammatory responses to surgery in a murine model. Br J Surg 1995; 82:10601065.

    • Search Google Scholar
    • Export Citation
  • 39.

    Balague CTargarona EMPujol M, et al. Peritoneal response to a septic challenge. Comparison between open laparotomy, pneumoperitoneum laparoscopy and wall lift laparoscopy. Surg Endosc 1999; 13:792796.

    • Search Google Scholar
    • Export Citation
  • 40.

    Maruszynski MPojda Z. Interleukin 6 (IL-6) levels in the monitoring of surgical trauma. Surg Endosc 1995; 9:882885.

  • 41.

    Hewitt PMIp SMKwok SP, et al. Laparoscopic-assisted vs. open surgery for colorectal cancer: comparative study of the immune effects. Dis Colon Rectum 1998; 41:901909.

    • Search Google Scholar
    • Export Citation
  • 42.

    Boni LBenevento ARovera F, et al. Infective complications in laparoscopic surgery. Surg Inf 2006;7(suppl 2):S109S111.

Advertisement

Comparison of surgical site infection rates in clean and clean-contaminated wounds in dogs and cats after minimally invasive versus open surgery: 179 cases (2007–2008)

Philipp D. Mayhew BVM&S, DACVS1, Lynetta Freeman DVM, MS, DACVS2, Toni Kwan DVM3, and Dorothy C. Brown DVM, MSCE, DACVS4
View More View Less
  • 1 Matthew J. Ryan Veterinary Hospital, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104
  • | 2 Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907.
  • | 3 Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907.
  • | 4 Matthew J. Ryan Veterinary Hospital, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104

Abstract

Objective—To report and compare the surgical site infection (SSI) rates for clean and clean-contaminated procedures performed by either a minimally invasive surgical or open surgical approach in a large population of dogs and cats.

Design—Prospective case series.

Animals—179 patients (dogs and cats) undergoing minimally invasive abdominal or thoracic surgery.

Procedures—Case information from all animals that underwent minimally invasive abdominal or thoracic surgery was prospectively collected and compared with an existing database of the same information collected from 379 patients undergoing laparotomy or thoracotomy via an open surgical approach. For both groups, an SSI was defined as any surgical wound in which purulent discharge was observed within 14 days after the procedure. Follow-up for all patients was obtained by direct examination or telephone interviews.

Results—Overall SSI rate in the minimally invasive surgery (MIS) group was 1.7% and in the open surgery (OS) group was 5.5%. On univariate analysis, there was a significantly lower SSI rate in the MIS group, compared with the SSI rate for the OS group. On multivariable logistic regression analysis, this difference appeared to be a result of the fact that surgery times were longer (median, 105 vs 75 minutes) and hair was clipped ≥ 4 hours prior to surgery for more animals (23% vs 11 %) in the OS group, compared with the MIS group.

Conclusions and Clinical Relevance—MIS may be associated with a lower SSI rate, compared with OS, but confounding factors such as differences in surgery time and preoperative preparation contributed in part to this finding. As such, surgical approach cannot be categorized as an independent risk factor for SSIs in small animals until further studies are performed.

Abstract

Objective—To report and compare the surgical site infection (SSI) rates for clean and clean-contaminated procedures performed by either a minimally invasive surgical or open surgical approach in a large population of dogs and cats.

Design—Prospective case series.

Animals—179 patients (dogs and cats) undergoing minimally invasive abdominal or thoracic surgery.

Procedures—Case information from all animals that underwent minimally invasive abdominal or thoracic surgery was prospectively collected and compared with an existing database of the same information collected from 379 patients undergoing laparotomy or thoracotomy via an open surgical approach. For both groups, an SSI was defined as any surgical wound in which purulent discharge was observed within 14 days after the procedure. Follow-up for all patients was obtained by direct examination or telephone interviews.

Results—Overall SSI rate in the minimally invasive surgery (MIS) group was 1.7% and in the open surgery (OS) group was 5.5%. On univariate analysis, there was a significantly lower SSI rate in the MIS group, compared with the SSI rate for the OS group. On multivariable logistic regression analysis, this difference appeared to be a result of the fact that surgery times were longer (median, 105 vs 75 minutes) and hair was clipped ≥ 4 hours prior to surgery for more animals (23% vs 11 %) in the OS group, compared with the MIS group.

Conclusions and Clinical Relevance—MIS may be associated with a lower SSI rate, compared with OS, but confounding factors such as differences in surgery time and preoperative preparation contributed in part to this finding. As such, surgical approach cannot be categorized as an independent risk factor for SSIs in small animals until further studies are performed.

Contributor Notes

Dr. Mayhew's present address is Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

Dr. Kwan's present address is Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

Address correspondence to Dr. Mayhew (philmayhew@gmail.com).