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Developing a Risk Stratification Model for Surgical Site Infection after Abdominal Hysterectomy

  • Margaret A. Olsen (a1), James Higham-Kessler (a1), Deborah S. Yokoe (a2) (a3), Anne M. Butler (a1), Johanna Vostok (a4), Kurt B. Stevenson (a5) (a6), Yosef Khan (a5) (a6), Victoria J. Fraser (a1) and Prevention Epicenter Program, Centers for Disease Control and Prevention...

Abstract

Objective.

The incidence of surgical site infection (SSI) after hysterectomy ranges widely from 2% to 21%. A specific risk stratification index could help to predict more accurately the risk of incisional SSI following abdominal hysterectomy and would help determine the reasons for the wide range of reported SSI rates in individual studies. To increase our understanding of the risk factors needed to build a specific risk stratification index, we performed a retrospective multihospital analysis of risk factors for SSI after abdominal hysterectomy.

Methods.

Retrospective case-control study of 545 abdominal and 275 vaginal hysterectomies from July 1, 2003, to June 30, 2005, at 4 institutions. SSIs were defined by using Centers for Disease Control and Prevention/National Nosocomial Infections Surveillance criteria. Independent risk factors for abdominal hysterectomy were identified by using logistic regression.

Results.

There were 13 deep incisional, 53 superficial incisional, and 18 organ-space SSIs after abdominal hysterectomy and 14 organ-space SSIs after vaginal hysterectomy. Because risk factors for organ-space SSI were different according to univariate analysis, we focused further analyses on incisional SSI after abdominal hysterectomy. The maximum serum glucose level within 5 days after operation was highest in patients with deep incisional SSI, lower in patients with superficial incisional SSI, and lowest in uninfected patients (median, 189, 156, and 141 mg/dL, respectively; P = .005). Independent risk factors for incisional SSI included blood transfusion (odds ratio [OR], 2.4) and morbid obesity (body mass index [BMI], >35; OR, 5.7). Duration of operation greater than the 75th percentile (OR, 1.7), obesity (BMI, 30–35; OR, 3.0), and lack of private health insurance (OR, 1.7) were marginally associated with increased odds of SSI.

Conclusions.

Incisional SSI after abdominal hysterectomy was associated with increased BMI and blood transfusion. Longer duration of operation and lack of private health insurance were marginally associated with SSI.

Copyright

Corresponding author

Division of Infectious Diseases, Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63110-1093 (molsen@dom.wustl.edu)

References

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1.Whiteman, MK, Hillis, SD, Jamieson, DJ, et al.Inpatient hysterectomy surveillance in the United States, 2000–2004. Am J Obstet Gynecol 2008;198:3437.
2.Edwards, JR, Peterson, KD, Andrus, ML, Dudeck, MA, Pollock, DA, Horan, TC. National Healthcare Safety Network (NHSN) report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control 2008;36:609626.
3.Reilly, J, Allardice, G, Bruce, J, Hill, R, McCoubrey, J. Procedure-specific surgical site infection rates and postdischarge surveillance in Scotland. Infect Control Hosp Epidemiol 2006;27:13181323.
4.Shapiro, M, Munoz, A, Tager, IB, Schoenbaum, SC, Polk, BF. Risk factors for infection at the operative site after abdominal or vaginal hysterectomy. N Engl J Med 1982;307:16611666.
5.Kandula, PV, Wenzel, RP. Postoperative wound infection after total abdominal hysterectomy: a controlled study of the increased duration of hospital stay and trends in postoperative wound infection. Am J Infect Control 1993;21:201204.
6.Soper, DE, Bump, RC, Hurt, WG. Wound infection after abdominal hysterectomy: effect of the depth of subcutaneous tissue. Am J Obstet Gynecol 1995;173:465469.
7.Korn, AP, Grullon, K, Hessol, N, Lin, P, Siopak, J. Does vaginal cuff closure decrease the infectious morbidity associated with abdominal hysterectomy? J Am Coll Surg 1997;185:404407.
8.Persson, E, Bergstrom, M, Larsson, PG, et al.Infections after hysterectomy: a prospective nation-wide Swedish study. The Study Group on Infectious Diseases in Obstetrics and Gynecology within the Swedish Society of Obstetrics and Gynecology. Acta Obstet Gynecol Scand 1996;75:757761.
9.Taylor, G, Herrick, T, Mah, M. Wound infections after hysterectomy: opportunities for practice improvement. Am J Infect Control 1998;26:254257.
10.Ahmed, F, Wasti, S. Infectious complications following abdominal hysterectomy in Karachi, Pakistan. Int J Gynaecol Obstet 2001;73:2734.
11.Chongsomchai, C, Lumbiganon, P, Thinkhamrop, J, Ounchai, J, Vudhikamraksa, N. Placebo-controlled, double-blind, randomized study of prophylactic antibiotics in elective abdominal hysterectomy. J Hosp Infect 2002;52:302306.
12.Davies, A, Hart, R, Magos, A, Hadad, E, Morris, R. Hysterectomy: surgical route and complications. Eur J Obstet Gynecol Reprod Biol 2002;104:148151.
13.Eason, E, Wells, G, Garber, G, et al.Antisepsis for abdominal hysterectomy: a randomised controlled trial of povidone-iodine gel. BJOG 2004;111:695699.
14.Rodriguez, JF, Trobo, AR, Garcia, MV, et al.The effect of performance feedback on wound infection rate in abdominal hysterectomy. Am J Infect Control 2006;34:182187.
15.Leung, PL, Tsang, SW, Yuen, PM. An audit on hysterectomy for benign diseases in public hospitals in Hong Kong. Hong Kong Med J 2007;13:187193.
16.Anderson, DJ, Chen, LF, Sexton, DJ, Kaye, KS. Complex surgical site infections and the devilish details of risk adjustment: important implications for public reporting. Infect Control Hasp Epidemiol 2008;29:941946.
17.Molina-Cabrillana, J, Valle-Morales, L, Hernandez-Vera, J, Lopez-Carrio, I, Garcia-Hernandez, JA, Bolanos-Rivero, M. Surveillance and risk factors on hysterectomy wound infection rate in Gran Canaria, Spain. Eur J Obstet Gynecol Reprod Biol 2008;136:232238.
18.Gaynes, RP. Surgical-site infections and the NNIS SSI Risk Index: room for improvement. Infect Control Hosp Epidemiol 2000;21:184185.
19.Geubbels, EL, Grobbee, DE, Vandenbroucke-Grauls, CM, Wille, JC, de Boer, AS. Improved risk adjustment for comparison of surgical site infection rates. Infect Control Hosp Epidemiol 2006;27:13301339.
20.Yokoe, DS, Noskin, GA, Cunningham, SM, et al.Enhanced identification of postoperative infections among inpatients. Emerg Infect Dis 2004;10:19241930.
21.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for the prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20:250280.
22.Allison, PD. Missing Data. Thousand Oaks, CA: Sage Publications; 2001.
23.SAS Institute. SAS OnlineDoc, version 8. SAS Institute; 2001. Available at: http://support.sas.com/documentation/onlinedoc/v82/whatsnew/zenid-96.htm. Accessed March 1, 2008.
24.Thomas, EJ, Goldman, L, Mangione, CM, et al.Body mass index as a correlate of postoperative complications and resource utilization. Am J Med 1997;102:277283.
25.Olsen, MA, Lock-Buckley, P, Hopkins, D, Polish, LB, Sundt, TM, Fraser, VJ. The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. J Thorac Cardiovasc Surg 2002;124:136145.
26.Olsen, MA, Lefta, M, Dietz, JR, et al.Risk factors for surgical site infection after major breast operation. J Am Coll Surg 2008;207:326335.
27.Walz, JM, Paterson, CA, Seligowski, JM, Heard, SO. Surgical site infection following bowel surgery: a retrospective analysis of 1446 patients. Arch Surg 2006;141:10141018.
28.Banbury, MK, Brizzio, ME, Rajeswaran, J, Lytle, BW, Blackstone, EH. Transfusion increases the risk of postoperative infection after cardiovascular surgery. J Am Coll Surg 2006;202:131138.
29.Vamvakas, EC, Blajchman, MA. Transfusion-related immunomodulation (TRIM): an update. Blood Rev 2007;21:327348.
30.Hager, DW, Larsen, JW. Postoperative infections: prevention and management. In: Rock, JA, Jones, HW III eds. Te Linde's Operative Gynecology. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008:190202.
31.Wexler, DJ, Nathan, DM, Grant, RW, Regan, S, Van Leuvan, AL, Cagliero, E. Prevalence of elevated hemoglobin A1c among patients admitted to the hospital without a diagnosis of diabetes. J Clin Endocrinol Metab 2008;93:42384244.
32.Charfen, MA, Ipp, E, Kaji, AH, Saleh, T, Qazi, MF, Lewis, RJ. Detection of undiagnosed diabetes and prediabetic states in high-risk emergency department patients. Acad Emerg Med 2009;16:394402.

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