Research Article | Open Access | 10.31586/Surgery.0201.05

Measuring Quality: The Impact of Minimally Invasive Surgery and Operative Time on Surgical Site Infections

  • Deborah S Keller1, Santosh Agarwal2, Patrick J Recio3, Daniel P Geisler3 and Eric M Haas4,5,*
    Colorectal Surgical Associates, Houston, USA
    Healthcare Outcomes Research Group, Covidien, Mansfield, USA
    Saint Vincent Health Center, Allegheny Health Network, Erie, USA
    Colorectal Surgical Associates, Division of Minimally Invasive Colorectal Surgery, USA
    Department of Surgery, University of Texas Medical School at Houston, Houston Methodist Hospital, Houston, USA


Objective: To evaluate the relationship between operative approach, operative time, and SSI rate. Methods: Inpatient database review identified patients undergoing 5 common procedures from 1/2010-12/2011. Patients were stratified into laparoscopic or open approaches. The main outcome measure was the relationship between operative time and SSI by approach. Results: 226,006 patients were evaluated- 28.2% open and 71.8% laparoscopic. Mean overall operative time was significantly shorter laparoscopically (p<0.001). Laparoscopy was associated with significantly lower costs and shorter length of stay (LOS) overall and for each procedure(p<0.0001). Multivariate analysis found SSI increased directly with operative time: for every 30-minute increase, SSI risk increased by 12%. Operative approach was an independent risk factor for SSI: open surgery increased SSI risk by 78%. A direct relationship between open procedures, operative time, and SSI risk was found. Conclusions: Laparoscopy has overall shorter operative time and improved outcomes in SSI rate, LOS, and total costs for common surgical procedures. As operative time and approach were independent risk factors for SSI, the use of laparoscopy and operative time are valuable quality measures.


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