{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T14:30:04Z","timestamp":1758637804280,"version":"3.37.3"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T00:00:00Z","timestamp":1676592000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["JP21fk0108604"],"award-info":[{"award-number":["JP21fk0108604"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["JP21fk0108604"],"award-info":[{"award-number":["JP21fk0108604"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Surgical site infections (SSIs) are among the most common healthcare-associated infections. Laparoscopy is increasingly being used in various surgical procedures. However, no study has examined the association between the proportion of laparoscopic procedures and the incidence of SSIs in digestive surgery using nationwide surveillance data.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We retrospectively investigated national SSI surveillance data from the Japan Nosocomial Infections Surveillance between 2009 and 2019. The annual trend of the SSI rate and the proportion of laparoscopic procedures were assessed, focusing on five major digestive surgeries. This was based on data from 109,544 (appendix surgery), 206,459 (gallbladder surgery), 60,225 (small bowel surgery), 363,677 (colon surgery), and 134,695 (rectal surgery) procedures. The effect of a 10% increase in the proportion of laparoscopic procedures on the reduction of the SSI rate was estimated using mixed-effect logistic regression.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Findings<\/jats:title>\n<jats:p>The average SSI rate of the five digestive surgeries decreased from 11.8% in 2009 to 8.1% in 2019. The proportion of laparoscopic procedures in each of the five digestive surgeries increased continuously (p&lt;0.001). The SSI rate for laparoscopic procedures was always lower than that for open procedures. The results were consistent between all and core hospitals participating in the surveillance. The odds ratios of the 10% increase in the proportion of laparoscopic procedures for five digestive surgeries were always &lt;0.950 (<jats:italic>p<\/jats:italic>&lt;0.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>An increase in the proportion of laparoscopic procedures was associated with a reduction in the SSI rate in digestive surgeries.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0281838","type":"journal-article","created":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T18:35:36Z","timestamp":1676658936000},"page":"e0281838","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Association between the proportion of laparoscopic approaches for digestive surgeries and the incidence of consequent surgical site infections, 2009\u20132019: A retrospective observational study based on national surveillance data in Japan"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7576-2654","authenticated-orcid":true,"given":"Toshiki","family":"Kajihara","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koji","family":"Yahara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aki","family":"Hirabayashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yumiko","family":"Hosaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norikazu","family":"Kitamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Motoyuki","family":"Sugai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keigo","family":"Shibayama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,2,17]]},"reference":[{"issue":"13","key":"pone.0281838.ref001","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1056\/NEJMoa1306801","article-title":"Multistate point-prevalence survey of health care-associated infections","volume":"370","author":"SS Magill","year":"2014","journal-title":"N Engl J Med"},{"issue":"22","key":"pone.0281838.ref002","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1001\/jamainternmed.2013.9763","article-title":"Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system","volume":"173","author":"E Zimlichman","year":"2013","journal-title":"JAMA Intern Med"},{"issue":"5","key":"pone.0281838.ref003","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1111\/j.1463-1318.2009.01817.x","article-title":"Surgical site infection rate is lower in laparoscopic than open colorectal surgery","volume":"12","author":"DP Howard","year":"2010","journal-title":"Colorectal Dis"},{"issue":"2","key":"pone.0281838.ref004","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.jamcollsurg.2010.03.028","article-title":"Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program","volume":"211","author":"RP Kiran","year":"2010","journal-title":"J Am Coll Surg"},{"issue":"4","key":"pone.0281838.ref005","doi-asserted-by":"crossref","first-page":"238","DOI":"10.5662\/wjm.v5.i4.238","article-title":"Laparoscopic surgery: A qualified systematic review","volume":"5","author":"A Buia","year":"2015","journal-title":"World J Methodol"},{"issue":"11","key":"pone.0281838.ref006","first-page":"CD001546","article-title":"Laparoscopic versus open surgery for suspected appendicitis","volume":"11","author":"T Jaschinski","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"pone.0281838.ref007","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1038\/s41598-019-57059-6","article-title":"Comparison of clinical outcomes between laparoscopic and open surgery for left-sided colon cancer: a nationwide population-based 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Endosc"},{"issue":"10","key":"pone.0281838.ref010","doi-asserted-by":"crossref","first-page":"e1913570","DOI":"10.1001\/jamanetworkopen.2019.13570","article-title":"Association of Open Approach vs Laparoscopic Approach With Risk of Surgical Site Infection After Colon Surgery","volume":"2","author":"DA Caroff","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"12","key":"pone.0281838.ref011","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1007\/s00268-017-4123-3","article-title":"Systematic Review and Meta-Analysis of Laparoscopic Versus Open Appendicectomy in Adults with Complicated Appendicitis: an Update of the Literature","volume":"41","author":"C Athanasiou","year":"2017","journal-title":"World J Surg"},{"issue":"2","key":"pone.0281838.ref012","first-page":"268","article-title":"Evaluation of laparoscopic surgery for small bowel obstruction and factors related to outcomes","volume":"15","author":"H Kayano","year":"2020","journal-title":"Wideochir Inne Tech 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Results from 10 years of surveillance in Germany","volume":"8","author":"SJS Aghdassi","year":"2019","journal-title":"Antimicrob Resist Infect Control"},{"issue":"10","key":"pone.0281838.ref015","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.ajic.2009.10.001","article-title":"National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009","volume":"37","author":"JR Edwards","year":"2009","journal-title":"Am J Infect Control"},{"issue":"2","key":"pone.0281838.ref016","first-page":"97","article-title":"Guideline for Prevention of Surgical Site Infection, 1999. 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