|
|
Back to 2018 Posters
INCISION LENGTH IS DIRECTLY RELATED TO THE RATE OF SUPERFICIAL AND DEEP INCISIONAL SSI's IN RECTAL CANCER PATIENTS WHO UNDERGO LAR AND ANASTOMOSIS.
Hiromichi Miyagaki*1,2, Carl Winkler2, Sandhu K. Jaspreet2, H M C Shantha Kumara2, Erica Pettke2, Daniel Galante2, Elie Sutton2, Richard L. Whelan2
1Saiseikai Senri Hospital, Suita, Osaka, Japan; 2Surgery, Mount Sinai West Hospital, New York, NY
Background: The NSQIP database now collects more detailed data regarding minimally invasive methods (MIS, MIS assist) and also notes converted cases. Although no incision length (IL) data is given, it can be assumed that the mean IL length will be shortest in MIS cases, longest in the open and converted cases and that the MIS assist IL will fall between open and MIS values. This review of NSQIP LAR cases for rectal cancer was carried out to assess the relationship between surgical method and superficial SSI's (sSSI's) and deep incisional SSI's (dSSI's).
Methods: The study period was 2012 to 2015. Inclusion criteria were for indications 154.1 (ICD9) or C20 (ICD10) and main CPT codes 44145, 44146, 44207 or 44208. Exclusion criteria were: totally or partly dependent health status, ventilator dependence, ascites/renal failure, CHF, sepsis, emergencies and ASA 5. Demographic parameters, comorbidities, pretreatment, cancer stage, postop complications including sSSI's and deep SSI's in Procedure Targeted and Standard Patient User File were reviewed. The propensity score matching method was used for comparing the rate of sSSI and dSSI to reduce of each pair of the background. Converted cases constituted their own group and were not considered in their MIS origin group (no intent to treat analysis).
Results: A total of 2,691 LAR cases with anastomoses met entry criteria. The surgical methods used were: MIS, 826 patients (30.6%); MIS with assist, 880 (32.7%); MIS converted to open 199 (7.4%); and open 786 (29%). Both MIS methods were associated with a significantly higher rate of splenic flexure takedown than the open group. Open patients were more likely to require adhesiolysis (MIS 0.2%, MIS assist 0.1%, Open 5%, p<0.05 for both) and to be diverted (vs MIS, p<0.05; vs MIS assist, p=0.07). There was stepwise and significant increases in the rate of sSSI and dSSI (combined incidence given) from the MIS (1.6%) to the MIS assist (3.5%), to the open group (6.4%). Of note, the highest rate of SSI's were noted in the converted group (sSSI+dSSI=9.5%). Surprisingly, 52% of open patients got preop oral antibiotics vs 47% for the converted patients, 37% of MIS and 43% of MIS assist group(p <0.0002 for both). Of note, there was no difference in the rate of organ space SSI or anastomotic leaks between groups (p>0.05).
Conclusion: Despite lower rates of oral antibiotic use in the MIS groups, significantly lower rates of sSSI's and dSSI's were noted in the MIS group than in the Open group; the MIS assist rate falls between that of the MIS and Open groups(p<0.05 for all sSSI comparisons and for the MIS vs Open & MIS assist vs Open dSSI comparisons). These results suggest that IL directly correlates with sSSI and dSSI rates. The highest sSSI and dSSI rates were seen in the converted patients.
Back to 2018 Posters
|
