title: Clinical and economic burden of surgical site infection in hysterectomy.
abstract: BACKGROUND
  Owing to a lack of current understanding of outcomes and costs by type of hysterectomy procedure, we attempt to quantify the incidence and impact of surgical site infection (SSI) in laparoscopic and non-laparoscopic approaches to abdominal and vaginal hysterectomy.
  
  
  METHODS
  Patients whose data were contained in the Premier Perspectives Database of 600 hospitals in the United States were selected on the basis of a post-operative diagnosis of SSI and treatment with antibiotics. The incidence of SSI and associated hospital length of stay (LOS) and costs were estimated. The effect of SSI on readmission was also analyzed.
  
  
  RESULTS
  Of 210,916 hysterectomies included in the study, 55% were open abdominal procedures. Although the overall incidence of SSI in hysterectomy was low, its incidence was greater in open abdominal hysterectomy than in other approaches to hysterectomy. Patients with an SSI experienced a three- to five-fold greater LOS, two-fold greater cost, and three-fold greater risk of hospital readmission than those without an SSI.
  
  
  CONCLUSIONS
  This study provides clinical evidence in support of less invasive approaches to hysterectomy. In addition to other documented benefits of such less invasive procedures, the lower incidence of SSIs and lower rates of associated complications and costs with these procedures than with open abdominal hysterectomy should be taken into account when weighing the risks and benefits of a surgical approach for patients whose condition warrants hysterectomy.
authors.affiliation: 1 Health Economics and Outcomes Research, Johnson & Johnson Global Surgery Group , Somerville, New Jersey.
authors.forename: Sanjoy
authors.initials: S
authors.lastname: Roy
authors.forename: Anuprita
authors.initials: A
authors.lastname: Patkar
authors.forename: Mehmet
authors.initials: M
authors.lastname: Daskiran
authors.forename: Ronald
authors.initials: R
authors.lastname: Levine
authors.forename: Piet
authors.initials: P
authors.lastname: Hinoul
authors.forename: Somesh
authors.initials: S
authors.lastname: Nigam
mesh_terms: D000328:Adult; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods*; D015994:Incidence; D007902:Length of Stay; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000473:pathology*; D014481:United States / Q000453:epidemiology