Risk Factors of Surgical Site Infection (SSI) in Patients Who Underwent Single-port or Multi-port Laparoscopic Gynecological Surgeries

Objective: This study aimed to estimate the incidence of surgical site infection (SSI) and identify its risk factors, in patients who underwent laparoscopic surgery. Method: A retrospective analysis of our hospital’s database was performed. Patients who were diagnosed with adnexal tumor or ectopic pregnancy and underwent laparoscopic surgery for the same between April 2012 and March 2016 were included. The following risk factors were studied: the amount of bleeding during surgery, operative approach (single-port or multi-port), operative procedure (cystectomy, salpingo-oophorectomy or salpingectomy), duration of the surgery, history of diabetes mellitus (DM), body mass index (BMI) and age. For each factor, univariate analysis was performed. Then multivariate analysis was performed for the factors found to be significant. Result: A total of 326 laparoscopic surgeries were performed during the period. The incidence of SSI was 1.8%（6/326). The study found that all of the patients who were diagnosed with SSI were operated upon using the approach of single-port laparoscopy. Furthermore, univariate analyses showed that advanced age, single-port operative approach and the procedure of salpingo-oophorectomy were significant risk factors for SSI (p<0.05). However, these three factors were mutually confounding. Multivariate analysis indicated that advanced age（odds ratio: 1.07; 95% confidence interval, 1.02-1.13）was the most significant risk factor for SSI. Conclusion: According to this study, SSI was associated with advanced age. However, older patients often opted for salpingo-oophorectomy, which was often performed via the single-port laparoscopic approach in our hospital. These three factors - age, salpingo-oophorectomy and single-port laparoscopic surgery - were significantly correlated with each other and are confounding factors. Hence, we need to have a high index of suspicion to prevent SSIs, especially for older patients who undergo single port laparoscopy gynecological surgeries.