Highlights
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Background
To identify risk factors for surgical site infections (SSIs) following abdominal hysterectomy (HYST) procedures using National Healthcare Safety Network (NHSN) data augmented with available diagnosis codes using data administrative.
Methods
We analyzed 66,001 HYST procedures at 166 New York State hospitals between January 2015 and December 2018, reported in NHSN and compared to billing data. Risk factors for surgical site infections (SSI) after abdominal HYST were identified using logistic regression models.
Results
A total of 66,001 HYST procedures were analyzed . SSI was reported after 1093 procedures, resulting in an infection rate of 1.66%.
Risk factors associated with surgical site infections (SSI) were the open (non-laparoscopic) approach with an adjusted odds ratio (AOR) of 2.72 and a 95% confidence interval (CI) of 2.37- 3.12, contaminated or dirty wound class (AOR 2.28, 95% CI 1.61-3.24), body mass index ≥30 (AOR 1.78, 95% CI 1.56-2, 02), procedures lasting 186 minutes or more (AOR 1.78, 95% CI 1.56-2.02), American Society of Anesthesia (ASA) score ≥3 (AOR 1.74, 95% CI 1 .52-1.99), gynecological cancer (AOR 1.54, 95% CI 1.32-1.80) and diabetes mellitus (AOR 1.46, 95% CI 1.24-1.70).
Conclusions Obesity, prolonged procedure duration, diabetes mellitus, wound contamination, open approach, ASA score ≥3, and gynecologic cancer were significant independent risk factors associated with surgical site infections (SSIs) after abdominal hysterectomy ( HYST). |
Comments
Findings from an analysis of more than 66,000 abdominal hysterectomies performed in New York hospitals reveal key risk factors for surgical site infections (SSIs) after these procedures, including open surgery, obesity, diabetes, gynecologic cancer and age under 45 years. Published in the American Journal of Infection Control (AJIC), the data can help inform surgical and clinical decisions to reduce postoperative infections.
"A better understanding of the clinical, surgical and patient-related factors associated with SSI in hysterectomy, a common surgical procedure in the United States, could help reduce infections and improve risk models," said Boldtsetseg Tserenpuntsag, DrPH, Director - Data Unit, Office of Healthcare Associated Infections, New York State Department of Health, and the lead author of the published study. "To the best of our knowledge, our findings are derived from the most comprehensive data set to date, making them more generalizable compared to previous studies on this topic."
Surgical site infections are infections that occur at the site of a surgical incision within 30 days after the incision is made.
According to the Centers for Disease Control and Prevention, surgical site infections (SSIs) account for 20% of all healthcare-associated infections (HAIs) and are associated with an increase of 2 to 11 times the risk of mortality. SSI is also the most expensive type of HAI with an estimated annual cost of $3.3 billion.
To identify risk factors for SSI after abdominal hysterectomy, Dr. Tserenpuntsag and colleagues used data reported in the National Healthcare Safety Network (NHSN) from 66,001 abdominal hysterectomies performed over four years across all hospitals. acute care in New York State (166). They augmented this data with diagnosis codes available in administrative data.
Among the 66,001 procedures the researchers analyzed, 1093 (1.66%) SSIs were reported. After adjusting for other risk factors, the analysis showed that patients with the following independent risk factors were significantly more likely to experience surgical site infections (SSIs):
- Under 45 years: Adjusted odds ratio (AOR) of 1.65 (under 35 years) and 1.21 (35-44 years).
- Open laparotomic (i.e., non-laparoscopic) approach: AOR 2.75.
- Contaminated/dirty wound classification: AOR of 2.28.
- Obesity (body mass index >30): AOR of 1.78.
- Procedure time greater than 186 minutes: AOR of 1.78.
- American Society of Anesthesia (ASA) score >3: AOR 1.74.
- Having gynecological cancer: AOR of 1.54.
- Having diabetes: AOR of 1.46.
“Given the size and rigor of this analysis, the findings contribute significantly to our understanding of surgical site infections (SSIs) and should provide valuable information to improve surgical planning and therefore help prevent postsurgical infections.” said Patricia Jackson, RN, MA, CIC, FAPIC, 2023 APIC president.
