title: Surgical site infection after primary surgery for epithelial ovarian cancer: predictors and impact on survival.
abstract: OBJECTIVE
  Surgical site infection (SSI) following epithelial ovarian cancer (EOC) primary surgery (PS) occurs in 10-15% of women. Perioperative factors associated with SSI and impact of SSI on survival were determined.
  
  
  METHODS
  EOC cases that underwent PS from 1/2/2003 to 12/30/2011 were retrospectively reviewed. SSIs were defined according to ACS NSQIP. Logistic regression models were fit to identify factors associated with SSI. Cox proportional hazards models were utilized to evaluate the association of patient and perioperative characteristics with overall survival (OS) and disease-free survival (DFS).
  
  
  RESULTS
  Among 888 cases, 96 (10.8%) developed SSI: 32 superficial, 2 deep, and 62 organ/space. Factors independently associated with superficial SSI were increasing BMI (odds ratio 1.41 [95% confidence interval, 1.12, 1.76] per 5kg/m(2)), increasing operative time (1.24 [1.02, 1.50] per hour), and advanced stage (III/IV) (10.22 [1.37, 76.20]). Factors independently associated with organ/space SSI were history of gastroesophageal reflux disease (2.13 [1.23, 3.71]), surgical complexity (intermediate 3.11 [1.02, 9.49]; high 8.07 [2.60, 25.09]; referent: low), and residual disease (RD) (measureable ≤1cm 1.77 [0.96, 3.27]; suboptimal >1cm (3.36 [1.48, 7.61]; referent: microscopic). Occurrence of superficial (hazard ratio 1.69 [1.12, 2.57]) or organ/space (1.46 [1.07, 2.00]) SSI was independently associated with worse OS. SSI occurrence was not independently associated with DFS.
  
  
  CONCLUSIONS
  SSI after PS is associated with decreased OS. Most risk factors for SSI are not modifiable. Alternative measures to lower rates of SSIs are needed as this may improve OS. Preoperative identification of SSI risk factors may assist in risk-assessment and operative planning.
authors.affiliation: Mayo Medical School Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Christine W
authors.initials: CW
authors.lastname: Tran
authors.affiliation: Division of Biomedical Statistics and Informatics, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Michaela E
authors.initials: ME
authors.lastname: McGree
authors.affiliation: Division of Biomedical Statistics and Informatics, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.affiliation: Surgery Research, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Janice R
authors.initials: JR
authors.lastname: Martin
authors.affiliation: Surgery Research, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Lemens
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Cliby
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Dowdy
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: bakkum.jamie@mayo.edu.
authors.forename: Jamie N
authors.initials: JN
authors.lastname: Bakkum-Gamez
mesh_terms: D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology* / Q000473:pathology; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Epithelial ovarian cancer; Primary cytoreduction; Primary surgery; Surgical outcomes; Surgical site infection