Methods: Study design: Matched case-control, two controls per case, matched on date of surgery. Study time: 1/1/2012 – 12/31/-2015. Procedures: abdominal and vaginal hysterectomies (open, laparoscopic, and robotic). Definitions: SSI (superficial incisional or deep/organ/space) within 30 days postoperatively, per CDC criteria. Statistical analysis: univariate analysis and conditional logistic regression controlling for demographic and clinical variables, both patient and surgery-related, including detailed prophylactic antibiotic exposure.
Results: Of the total 1,531 hysterectomies performed, we identified 52 SSIs (3%), with 60% being deep incisional or organ/space infections. All cases received appropriate preoperative antibiotics (timing, choice and weight-base dosing). Univariate analysis showed that: higher median weight, higher median Charlson comorbidity index, immune suppressed state, ASA ≥ 3, prior surgery within 60 days, clindamycin/gentamicin prophylaxis, surgery involving the omentum or GI tract, longer surgery duration, ≥ 4 surgeons present in the OR, higher median blood loss, ≥ 7 catheters or invasive devices in the OR, and higher median length of hospital stay increased SSI risk (P < 0.05 for all). Cefazolin preoperative prophylaxis , robotic assisted surgery, and laparoscopic surgery were protective (P < 0.05 for all). Duration of surgery was the only independent risk factor for SSI identified on multivariate analysis (OR 3.45 [1.21 - 9.76], P = 0.02).
Conclusion: In our population of women with multi-morbidity and hysterectomies largely due to underlying gynecological malignancies, duration of surgery, presumed a marker of surgical complexity, is a significant SSI risk factor. Interestingly, the choice of pre-operative antibiotic did not alter SSI risk in our study.
M. Schmitz, None
A. Al-Niaimi, None
N. Safdar, None