Robotic-assisted radical prostatectomy decreases the incidence and morbidity of surgical site infections

Objective: To determine the incidence and morbidity of surgical site infections (SSI) during prostatectomy, and determine the association with surgical approach. The development of a SSI after radical prostatectomy is associated with increased cost and significant morbidity. However, existing comparisons between open and robotic surgery have been made comparing a contemporary robotic experience with historical cohorts undergoing open surgery. Methods: We reviewed the incidence of SSI in 5908 consecutive patients undergoing both retropubic radical prostatectomy (RRP; n = 4824 [81.7%]) and robotic-assisted radical prostatectomy (RARP; n = 1084 [18.3%]) at our institution between 2004 and 2008. Patient records were reviewed for the development and treatment of an SSI, defined as wound erythema or cellulitis that necessitated antibiotic therapy or opening of the surgical wound within 30 days of surgery. Results: In total, 222 (3.7%) patients developed an SSI. Those undergoing RARP (6/1084, 0.6%) were significantly less likely to develop an SSI than patients undergoing RRP (216/4824, 4.5%) (P <.001). Furthermore, SSIs in patients undergoing RARP resolved more quickly (median, 7 vs 16 days) and were less likely to require wound incision and/or drainage (1 vs 84 patients), hospital readmission (0 vs 11 patients), or return to the operating room for debridement (0 vs 6 patients). Conclusions: Patients undergoing RARP are less likely to develop SSIs than patients undergoing RRP. Furthermore, the infections that develop after minimally invasive surgery are less severe. Continued investigation into the mechanisms of SSIs are needed to further decrease patient morbidity.