The aims of this study were to estimate the occurrence of postoperative surgical site infections (SSIs) after different routes of hysterectomy and to identify associated risk factors. The investigators conducted a secondary cross-sectional analysis of the 2005Y2009 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) to examine data files of women undergoing hysterectomies. The primary hysterectomy routes compared were laparotomy and the vaginal approach. The main study outcome was the occurrence of 30-day superficial SSI (cellulitis) after hysterectomy; secondary outcomes were the occurrence of deep and organ-space SSI. Logistic regression models were used to examine associations of risk factors after hysterectomy. The final analysis included 13,822 women who had undergone hysterectomy.The occurrence of cellulitis after hysterectomy was 1.6% (221/13,822). Multivariate analysis showed that the following risk factors were associated with 30-day postoperative cellulitis: route of hysterectomy (adjusted odds ratio [aOR], 3.74; 95% confidence interval [CI], 2.26Y6.22 for laparotomy compared with the vaginal approach), operative time greater than 75th percentile (aOR,1.84; 95% CI, 1.40Y2.44), American Society of Anesthesia Class 3 or greater (aOR, 1.79; 95% CI, 1.31Y2.43), morbid obesity (body mass index Q40 kg/m 2 ) (aOR, 2.65; 95% CI, 1.85Y3.80), and diabetes mellitus (aOR, 1.54; 95% CI, 1.06Y2.24). The occurrence of deep and organ-space SSI after hysterectomy was 1.1% (154/13,822).These data show decreased occurrence of superficial SSI after use of the vaginal approach for hysterectomy and reaffirm the role for vaginal hysterectomy as the route of choice for hysterectomy.

Objective Our objective was to estimate the occurrence of surgical site infections (SSI) after hysterectomy and associated risk factors. Study Design We conducted a cross-sectional analysis of the 2005-09 American College of Surgeons National Surgical Quality Improvement Program participant use data files to analyze hysterectomies. Different routes of hysterectomy were compared. The primary outcome was to identify the occurrence of 30-day superficial SSI (cellulitis) after hysterectomy. Secondary outcomes were the occurrence of deep and organ-space SSI after hysterectomy. Logistic regression models were conducted to further explore the associations of risks factors with SSI after hysterectomy. Results A total of 13,822 women were included in our final analysis. The occurrence of postoperative cellulitis after hysterectomy was 1.6% (n= 221). Risk factors associated with cellulitis were route of hysterectomy with an adjusted odds ratio (AOR) of 3.74 (95% CI 2.26-6.22) for laparotomy compared with the vaginal approach, operative time > 75th percentile (AOR = 1.84, 95% CI 1.40-2.44), American Society of Anesthesia Class ≥ 3 (AOR 1.79, 95% CI 1.31-2.43), body mass index ≥ 40kg/m2 (AOR 2.65, 95% CI 1.85-3.80), and diabetes mellitus (AOR 1.54, 95% CI 1.06-2.24) The occurrence of deep and organ-space SSI was 1.1% (n= 154) after hysterectomy. Conclusion Our finding of the decreased occurrence of superficial SSI after vaginal approach for hysterectomy reaffirms the role for vaginal hysterectomy as the route of choice for hysterectomy.

Objective Our primary objective is to estimate the occurrence of major maternal 30 day postoperative complications after nonobstetric antenatal surgery. Methods We analyzed the 2005-2009 data files from the American College of Surgeons National Surgical Quality Improvement Program to assess outcomes for pregnant women undergoing nonobstetric antenatal surgery during any trimester of pregnancy as classified by CPT-4 codes. T-tests, χ2, logistic regression and other tests were used to calculate composite 30-day major postoperative complications and associations of preoperative predictors with 30 day postoperative morbidity. Results The most common non-obstetric antenatal surgical procedure among the 1,969 included women was appendectomy (44.0%). The prevalence of composite 30-day major postoperative complications was 5.8% (n=115). This included (not exclusive categories): return to the surgical operating room within 30 days of surgery 3.6%, infectious morbidity 2.0%, wound morbidity 1.4%, 30 day respiratory morbidity 2.0%, venous thromboembolic event morbidity 0.5%, postoperative blood transfusion 0.2%, and maternal mortality 0.25%. Conclusion Major maternal postoperative complications following nonobstetric antenatal surgery were low (5.8%). Maternal postoperative mortality was rare (0.25%).

We obtained valid Spanish translations of the PFDI-20, PFIQ-7, QUID, and 3IQ. These results support their use as clinical and research assessment tools in Spanish-speaking populations.

The evaluation of female patients with AMH needs to be tailored to the individual patient's presentation and risk factors. This evaluation should be timely and always include testing of both upper and lower urinary tract. After a complete negative assessment, no further follow-up is needed.