title: Beyond core measures: identifying modifiable risk factors for prevention of surgical site infection after elective total abdominal hysterectomy.
abstract: BACKGROUND
  Despite adherence to the Centers for Medicare and Medicaid Services (CMS) core measures for preventing surgical site infections (SSI), our institution has a >10% rate of SSI after total abdominal hysterectomy (TAH), higher than the 90(th) percentile for SSI rates published in the 2009 National Healthcare Safety Network report.
  
  
  METHODS
  A retrospective chart review was performed for patients who underwent elective TAH at a public safety net hospital in Denver from December 30, 2005, to March 9, 2010. The primary outcome was development of SSI within 30 days. A secondary outcome was adherence to CMS core measures.
  
  
  RESULTS
  A total of 192 patients were included in the analysis, of whom 21 (10.9%) developed SSI. More than 95% had received antibiotics in the 60 min before surgical incision, and >90% received an appropriate antibiotic. Compliance with post-anesthesia care unit normothermia was equivalent in the SSI and non-SSI groups (81.0% vs. 75.2%; p=0.5588). Surgical site infection was associated with obesity (body mass index [BMI]≥30) (15.4% vs. 6.9%; p=0.0609), estimated blood loss≥500 mL (18.5% vs. 8.0%; p=0.0353), and receipt of a blood transfusion (28.6% vs. 10.5%; p=0.0183). In a multiple logistic regression model, obesity marginally increased the risk of SSI (odds ratio [OR] 2.55; 95% confidence interval [CI] 0.94-6.74), whereas blood transfusion was significantly associated with a higher risk of SSI (OR 3.58; 95% CI 1.21-10.62).
  
  
  CONCLUSIONS
  Blood transfusion was associated with SSI after TAH in our population. As it is a modifiable risk factor, larger multi-center studies are needed to confirm this result and determine appropriate transfusion thresholds.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Denver Health Hospital & University of Colorado Health Sciences Center, Denver, Colorado, USA. heather.young@ucdenver.edu
authors.forename: Heather
authors.initials: H
authors.lastname: Young
authors.forename: Robin
authors.initials: R
authors.lastname: Bliss
authors.forename: J Chris
authors.initials: JC
authors.lastname: Carey
authors.forename: Connie S
authors.initials: CS
authors.lastname: Price
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003428:Cross Infection / Q000517:prevention & control*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control*; D065227:Transfusion Reaction
chemical_list: D000890:Anti-Infective Agents