694. Statewide Collaboration to Evaluate the Effects of Blood Loss and Transfusion on Surgical Site Infection after Hysterectomy
Session: Poster Abstract Session: Skin, Soft Tissue and Joint Infections
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • CO-TAH.pdf (543.5 kB)
  • Background: Few evidence-based measures are proven to decrease the rate of surgical site infection (SSI). Even hospitals with high adherence to the SSI prevention bundle can struggle with unacceptably high rates of SSI. Our institution noted high rate of SSI after total abdominal hysterectomy (TAH); we performed a retrospective review of patients to determine risk factors for SSI. Blood transfusion and estimated blood loss (EBL) ≥500 mL were associated with SSI in our pilot study. To determine if these variables remained significant across a broad hospital base, we collected data from several hospitals in the state of Colorado.

    Methods: Local infection control nurses reviewed charts of patients who underwent TAH between Aug 1, 2009, and July 31, 2010. Variables of interest included body mass index (BMI), pre-operative antibiotic choice and timing, pre-operative hematocrit, EBL, presence of blood transfusion, and development of SSI. A line listing of de-identified data was entered into a secure website designed and maintained by the Colorado Hospitals Association. The primary outcome was development of SSI within 30 days of TAH. Categorical and continuous variables were investigated using Fisher’s exact and Wilcoxon rank-sum tests, respectively. Tests were performed at the 0.05 significance level. After the bivariate analysis, interactions between potentially important risk factors were investigated and odds ratios for SSI were calculated.

    Results: Six sites participated in the study and 567 records were collected; 20 were excluded. Ten (1.8%) patients developed SSI and 35 (6.5%) received a blood transfusion. Two hundred twenty-three (40.8%) patients were obese and 38 (7.0%) had EBL ≥500 mL. Obesity (BMI ≥30) was not associated with SSI (P=0.30) although blood transfusion and EBL ≥500 mL trended toward an association with SSI (P=0.13 and P=0.15 respectively). Blood transfusion contributed most to SSI in patients with EBL <500 mL (OR 7.20, 95% CI 1.37-37.72).

    Conclusion: Consistent with our pilot data, blood transfusion and EBL ≥500 mL trended toward association with SSI after TAH. The effect of blood transfusion on SSI was strongest in patients with EBL <500 mL. Statewide research collaborations can help identify new risk factors for SSI.


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Heather Young, MD1, Crystal Berumen, MSPH2, Bryan Knepper, MPH, MSc1, Amber Miller, RN, MSN, CIC3, Morgan Silverman, MPH3, Heather Gilmartin, NP4, Elizabeth Wodrich, RN4, Sandy Alexander, RN5 and Connie Price, MD1, (1)Denver Health Medical Center, Denver, CO, (2)Colorado Hospital Association, Greenwood Village, CO, (3)Exempla Lutheran Medical Center, Wheat Ridge, CO, (4)Vail Valley Medical Center, Vail, CO, (5)Platte Valley Medical Center, Brighton, CO

    Disclosures:

    H. Young, None

    C. Berumen, None

    B. Knepper, None

    A. Miller, None

    M. Silverman, None

    H. Gilmartin, None

    E. Wodrich, None

    S. Alexander, None

    C. Price, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.