The aims of this study were to estimate the occurrence of postoperative surgical site infections (SSIs) after different routes of hysterectomy and to identify associated risk factors. The investigators conducted a secondary cross-sectional analysis of the 2005–2009 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) to examine data files of women undergoing hysterectomies. The primary hysterectomy routes compared were laparotomy and the vaginal approach. The main study outcome was the occurrence of 30-day superficial SSI (cellulitis) after hysterectomy; secondary outcomes were the occurrence of deep and organ-space SSI. Logistic regression models were used to examine associations of risk factors after hysterectomy. The final analysis included 13,822 women who had undergone hysterectomy.
The occurrence of cellulitis after hysterectomy was 1.6% (221/13,822). Multivariate analysis showed that the following risk factors were associated with 30-day postoperative cellulitis: route of hysterectomy (adjusted odds ratio [aOR], 3.74; 95% confidence interval [CI], 2.26–6.22 for laparotomy compared with the vaginal approach), operative time greater than 75th percentile (aOR,1.84; 95% CI, 1.40–2.44), American Society of Anesthesia Class 3 or greater (aOR, 1.79; 95% CI, 1.31–2.43), morbid obesity (body mass index ≥40 kg/m2) (aOR, 2.65; 95% CI, 1.85–3.80), and diabetes mellitus (aOR, 1.54; 95% CI, 1.06–2.24). The occurrence of deep and organ-space SSI after hysterectomy was 1.1% (154/13,822).
These data show decreased occurrence of superficial SSI after use of the vaginal approach for hysterectomy and reaffirm the role for vaginal hysterectomy as the route of choice for hysterectomy.
Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale University, School of Medicine, New Haven, CT