A Medical Device Daily

Ethicon Endo-Surgery (Cincinnati) has reported that laparoscopic surgery reduced the risk of nosocomial, or hospital-acquired, infections by 52% when compared to open surgery in a study of more than 11,000 patients undergoing one of the following three surgical procedures: hysterectomy, gallbladder removal 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%, and during hysterectomy by 52% compared to open surgery. The study showed the reduction rates of nosocomial infections during laparoscopic appendectomy were not statistically significant.

The results of the study were presented this past weekend at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES; Los Angeles) in Philadelphia and also will be published in the April edition of Surgical Endoscopy, the society's journal.

Ethicon Endo-Surgery, a unit of Johnson & Johnson (New Brunswick, New Jersey), develops devices for both minimally invasive and open surgical procedures, focusing on conditions in general and bariatric surgery, as well as gastrointestinal health, gynecology and surgical oncology.

The company-sponsored study is the first to examine infections specific to these procedures 30 days post-discharge, providing what it said is "a more comprehensive picture" of infection patterns than previously available. The authors reported that 40% of the infections identified occurred within 30 days after hospital discharge.

"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 Brill, MD, director of minimally invasive gynecology at California Pacific Medical Center (San Francisco), one of the lead investigators for the study.

Study results also showed that 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% reduction in the odds of respiratory tract infection, 69% reduction in bloodstream infection, 59% reduction in wound infection, 39% reduction in urinary tract infection and a 48% reduction in other types of nosocomial infections across hysterectomies, cholecystectomies and appendectomies.

In addition to the potential patient benefits due to reduced infection, the study data identified a variety of cost implications.

The study found that 27% of patients identified with a post-discharge infection were re-admitted to the hospital, marking an added cost for hospitals and payers. However, there was a 65% reduction in hospital readmissions for hospital-acquired infections when a patient underwent laparoscopic gallbladder removal and hysterectomy when compared to open surgery.

The retrospective study covered more than 11,000 patients for the period Sept. 1, 2004-Dec. 31, 2006, from 22 hospitals across 15 states that had undergone laparoscopic or open hysterectomy (43.3% of patients), gallbladder removal (32.7% of patients) and appendectomy (24% of patients).

In the study, 337 patients (2.89%) experienced at least one nosocomial infection. Overall, infection rates were nearly twice as high for open procedures (4.09%) than for laparoscopic procedures (2.11%).

The study used the Nosocomial Infection Marker (NIM), an algorithm designed by Cardinal Health (Dublin, Ohio) that monitors and tracks nosocomial infection rates for up to 30 days post-discharge. In a previous study, the NIM algorithm identified nosocomial infections with 86% sensitivity and 98.5% specificity.

Andrew Webber, president/CEO of the National Business Coalition on Health (Washington), said the study "demonstrates the significant impact minimally-invasive technology can have on patient care and healthcare cost-saving."

He added, "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."

The coalition, a non-profit, membership association of 60 business and health organizations, represents some 7,000 employers and 34 million covered lives.