Developing a risk stratification model for surgical site infection after abdominal hysterectomy.
OBJECTIVE
The incidence of surgical site infection (SSI) after hysterectomy ranges widely from 2% to 21%. A specific risk stratification index could help to predict more accurately the risk of incisional SSI following abdominal hysterectomy and would help determine the reasons for the wide range of reported SSI rates in individual studies. To increase our understanding of the risk factors needed to build a specific risk stratification index, we performed a retrospective multihospital analysis of risk factors for SSI after abdominal hysterectomy.


METHODS
Retrospective case-control study of 545 abdominal and 275 vaginal hysterectomies from July 1, 2003, to June 30, 2005, at 4 institutions. SSIs were defined by using Centers for Disease Control and Prevention/National Nosocomial Infections Surveillance criteria. Independent risk factors for abdominal hysterectomy were identified by using logistic regression.


RESULTS
There were 13 deep incisional, 53 superficial incisional, and 18 organ-space SSIs after abdominal hysterectomy and 14 organ-space SSIs after vaginal hysterectomy. Because risk factors for organ-space SSI were different according to univariate analysis, we focused further analyses on incisional SSI after abdominal hysterectomy. The maximum serum glucose level 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 141 mg/dL, respectively; 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 greater than the 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 duration of operation and lack of private health insurance were marginally associated with SSI.
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri 63110-1093, USA. molsen@dom.wustl.edu
Margaret A
MA
Olsen
James
J
Higham-Kessler
Deborah S
DS
Yokoe
Anne M
AM
Butler
Johanna
J
Vostok
Kurt B
KB
Stevenson
Yosef
Y
Khan
Victoria J
VJ
Fraser
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D015994:Incidence; D016015:Logistic Models; D008875:Middle Aged; D008954:Models, Biological; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D065227:Transfusion Reaction; D055815:Young Adult