title: Predictors and costs of surgical site infections in patients with endometrial cancer.
abstract: OBJECTIVE
  Technological advances in surgical management of endometrial cancer (EC) may allow for novel risk modification in surgical site infection (SSI).
  
  
  METHODS
  Perioperative variables were abstracted from EC cases surgically staged between January 1, 1999, and December 31, 2008. Primary outcome was SSI, as defined by American College of Surgeons National Surgical Quality Improvement Program. Counseling and global models were built to assess perioperative predictors of superficial incisional SSI and organ/space SSI. Thirty-day cost of SSI was calculated.
  
  
  RESULTS
  Among 1369 EC patients, 136 (9.9%) had SSI. In the counseling model, significant predictors of superficial incisional SSI were obesity, American Society of Anesthesiologists (ASA) score >2, preoperative anemia (hematocrit <36%), and laparotomy. In the global model, significant predictors of superficial incisional SSI were obesity, ASA score >2, smoking, laparotomy, and intraoperative transfusion. Counseling model predictors of organ/space SSI were older age, smoking, preoperative glucose >110 mg/dL, and prior methicillin-resistant Staphylococcus aureus (MRSA) infection. Global predictors of organ/space SSI were older age, smoking, vascular disease, prior MRSA infection, greater estimated blood loss, and lymphadenectomy or bowel resection. SSI resulted in a $5447 median increase in 30-day cost.
  
  
  CONCLUSIONS
  Our findings are useful to individualize preoperative risk counseling. Hyperglycemia and smoking are modifiable, and minimally invasive surgical approaches should be the preferred surgical route because they decrease SSI events. Judicious use of lymphadenectomy may decrease SSI. Thirty-day postoperative costs are considerably increased when SSI occurs.
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. bakkum.jamie@mayo.edu
authors.forename: Jamie N
authors.initials: JN
authors.lastname: Bakkum-Gamez
authors.forename: Sean C
authors.initials: SC
authors.lastname: Dowdy
authors.forename: Bijan J
authors.initials: BJ
authors.lastname: Borah
authors.forename: Lindsey R
authors.initials: LR
authors.lastname: Haas
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariani
authors.forename: Janice R
authors.initials: JR
authors.lastname: Martin
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: Michaela E
authors.initials: ME
authors.lastname: McGree
authors.forename: William A
authors.initials: WA
authors.lastname: Cliby
authors.forename: Karl C
authors.initials: KC
authors.lastname: Podratz
mesh_terms: D000368:Aged; D016889:Endometrial Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics* / Q000706:statistics & numerical data; D007045:Hysterectomy, Vaginal / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000191:economics*; D009367:Neoplasm Staging; D009765:Obesity / Q000453:epidemiology; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000191:economics* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
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