title: Surgical site infection after hysterectomy.
abstract: OBJECTIVE
  Our objective was to estimate the occurrence of surgical site infections (SSI) after hysterectomy and the associated risk factors.
  
  
  METHODS
  We conducted a cross-sectional analysis of the 2005-2009 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 women). Risk factors that were associated with cellulitis were route of hysterectomy with an adjusted odds ratio (AOR) of 3.74 (95% confidence interval [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 ≥40 kg/m(2) (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 women) after hysterectomy.
  
  
  CONCLUSIONS
  Our finding of the decreased occurrence of superficial SSI after the vaginal approach for hysterectomy reaffirms the role for vaginal hysterectomy as the route of choice for hysterectomy.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
authors.forename: AeuMuro Gashaw
authors.initials: AG
authors.lastname: Lake
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: McPencow
authors.forename: Madeline A
authors.initials: MA
authors.lastname: Dick-Biascoechea
authors.forename: Deanna K
authors.initials: DK
authors.lastname: Martin
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Erekson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002481:Cellulitis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000706:statistics & numerical data; D016015:Logistic Models; D009765:Obesity / Q000453:epidemiology; D061646:Operative Time; D034161:Pelvic Infection / Q000453:epidemiology*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
keywords: hysterectomy; outcome; postoperative complication; surgical site infection