Predictors of surgical site infection in women undergoing hysterectomy for benign gynecologic disease: a multicenter analysis using the national surgical quality improvement program data.
OBJECTIVE
To estimate the rate and predictors of surgical site infection (SSI) after hysterectomy performed for benign indications and to identify any association between SSI and other postoperative complications.


METHODS
Retrospective cohort study (Canadian Task Force classification II-2).


METHODS
National Surgical Quality Improvement Program data.


METHODS
Women who underwent abdominal or laparoscopic hysterectomy performed for benign indications from 2005 to 2011.


METHODS
Univariable and multivariable logistic regression analyses were used to identify predictors of SSI and its association with other postoperative complications. Odds ratios were adjusted for patient demographic data, comorbidities, preoperative laboratory values, and operative factors.


RESULTS
Of 28 366 patients, 758 (3%) were diagnosed with SSI. SSI occurred more often after abdominal than laparoscopic hysterectomy (4% vs 2%; p < .001). Among patients who underwent abdominal hysterectomy, predictors of SSI included diabetes, smoking, respiratory comorbidities, overweight or obesity, American Society of Anesthesiologists class ≥ 3, perioperative blood transfusion, and operative time >180 minutes. Among those who underwent laparoscopic hysterectomy, predictors of SSI included perioperative blood transfusion, operative time >180 minutes, serum creatinine concentration ≥ 2 mg/dL, and platelet count ≥ 350 000 cells/mL(3). For patients with deep or organ/space SSI, significant predictors included perioperative blood transfusion and American Society of Anesthesiologists class ≥ 3 for abdominal hysterectomy, and non-white race, renal comorbidities, preoperative or perioperative blood transfusion, and operative time >180 minutes for laparoscopic hysterectomy. SSI was associated with longer hospital stay and higher rates of repeat operation, sepsis, renal failure, and wound dehiscence. SSI was not associated with increased 30-day mortality.


CONCLUSIONS
SSI occurred more often after abdominal hysterectomy than laparoscopic hysterectomy performed to treat benign gynecologic disease. SSI was associated with increased postoperative complications but not mortality. Several risk factors for SSI after each abdominal and laparoscopic hysterectomy were identified in this study.
Division of Gynecologic Oncology, Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: mahdih@ccf.org.
Haider
H
Mahdi
Division of Gynecologic Oncology, Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.
Sarah
S
Goodrich
Department of Biostatistics, University of Washington, Seattle, WA.
David
D
Lockhart
Division of Gynecologic Oncology, Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.
Robert
R
DeBernardo
Division of Gynecologic Oncology, Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.
Mehdi
M
Moslemi-Kebria
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D005831:Genital Diseases, Female / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000592:standards*; D007902:Length of Stay; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D016017:Odds Ratio; D061646:Operative Time; D011237:Predictive Value of Tests; D058996:Quality Improvement; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D014481:United States / Q000453:epidemiology
Abdominal; Benign indications; Hysterectomy; Laparoscopic; Risk factors; Surgical site infection