1462. Surgical Site Infection (SSI) After Hysterectomy: Incidence and Risk Factors in a Tertiary Care Hospital
Session: Poster Abstract Session: HAI: Surgical Site Infections
Friday, October 28, 2016
Room: Poster Hall
Background: Preoperative antibiotic prophylaxis and surgical technological advances have greatly reduced, but not totally eliminated SSI post-hysterectomy. We aimed to identify risk factors for SSI post-hysterectomy among women with a high prevalence of gynecological malignancies, in a tertiary care setting where compliance with the US Joint Commission's Surgical Care Improvement Project (SCIP) core measures is excellent.

MethodsStudy 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.

Aurora Pop-Vicas, MD, MPH, Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, Jackson Musuuza, MD, MPH, MS, Institute for Clinical and Translational Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, Michelle Schmitz, CIC, Infection Control, University of Wisconsin Hospital and Clinics, Madison, WI, Ahmed Al-Niaimi, MD, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI and Nasia Safdar, MD, PhD, FSHEA, Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI

Disclosures:

A. Pop-Vicas, None

J. Musuuza, None

M. Schmitz, None

A. Al-Niaimi, None

N. Safdar, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.