Developing a Risk Stratification Model for Surgical Site Infection after Abdominal Hysterectomy

Abstract

Objective The incidence of surgical site infection (SSI) ranges widely from 2-21% after hysterectomy. There is insufficient understanding of risk factors to build a specific risk stratification index. Methods Retrospective case-control study of 545 abdominal and 275 vaginal hysterectomies from 7/1/03 - 6/30/05 at four institutions. SSIs were defined using CDC/NNIS criteria. Independent risk factors for abdominal hysterectomy were identified by logistic regression. Results There were 13 deep incisional, 53 superficial incisional, and 18 organ-space SSI after abdominal and 14 organ-space SSI after vaginal hysterectomy. Because risk factors for organ-space SSI were different in univariate analysis, further analyses focused on incisional SSI after abdominal hysterectomy. The maximum serum glucose within 5 days after operation was highest in patients with deep incisional SSI, lower in patients with superficial incisional SSI and lowest in uninfected patients (median 189, 156, and 141mg/dL, p = .005). Independent risk factors for incisional SSI included blood transfusion (odds ratio (OR) 2.4) and morbid obesity (body mass index (BMI) > 35, OR 5.7). Duration of operation > 75th percentile (OR 1.7), obesity (BMI 30-35, OR 3.0), and lack of private health insurance (OR 1.7) were marginally associated with increased odds of SSI. Conclusions Incisional SSI after abdominal hysterectomy was associated with increased BMI and blood transfusion. Longer operative time and lack of private health insurance were marginally associated with SSI. A specific risk stratification index could help to more accurately predict the risk of incisional SSI following abdominal hysterectomy.

Risk factors for postoperative complications after fast‐track abdominal hysterectomy

“…The study showed that obesity was a strong risk factor for postoperative complications even in a fast track setting. This agrees with results from other studies of benign abdominal hysterectomy 3,4,6,19 . Contrary to the finding presented by Brummer et al 3 we found that previous laparotomy was strongly associated with an increased risk of complications.…”

Abdominal Hysterectomy: Reduced Risk of Surgical Site Infection Associated with Robotic and Laparoscopic Technique

“…Other independent risk factors in our cohort were morbid obesity (BMI > 40), advanced age ( > 75 y), and dirty or contaminated wound classes, which are similar to risk factors reported by others [14][15][16]. In these studies, blood transfusion, diabetes mellitus, and smoking have also been identified as risk factors for SSI after hysterectomy.…”

External Validation of the Ventral Hernia Risk Score for Prediction of Surgical Site Infections

“…Morbid obesity and elevated ASA class are widely considered risk factors for complications of surgery [10][11][12]. Thus, ASA class ‡ 3 was an independent risk factor for SSI.…”