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Surgical Site Infection in Women Undergoing Surgery for Gynecologic Cancer

Mahdi, Haider MD*; Gojayev, Anar MD*; Buechel, Megan MD*; Knight, Jason MD*; SanMarco, Janice MD*; Lockhart, David BS; Michener, Chad MD*; Moslemi-Kebria, Mehdi MD*

International Journal of Gynecological Cancer: May 2014 - Volume 24 - Issue 4 - p 779–786
doi: 10.1097/IGC.0000000000000126
Surgeons Corner

Objectives The objectives of this study were to describe the rate and predictors of surgical site infection (SSI) after gynecologic cancer surgery and identify any association between SSI and postoperative outcome.

Materials and Methods Patients with endometrial, cervical, or ovarian cancers from 2005 to 2011 were identified from the American College of Surgeons National Surgical Quality Improvement Program. The extent of surgical intervention was categorized into modified surgical complexity scoring (MSCS) system. Univariate and multivariate logistic regression analyses were used. Odds ratios were adjusted for patient demographics, comorbidities, preoperative laboratory values, and operative factors.

Results Of 6854 patients, 369 (5.4%) were diagnosed with SSI. Surgical site infection after laparotomy was 3.5 times higher compared with minimally invasive surgery (7% vs 2%; P < 0.001). Among laparotomy group, independent predictors of SSI included endometrial cancer diagnosis, obesity, ascites, preoperative anemia, American Society of Anesthesiologists class greater than or equal to 3, MSCS greater than or equal to 3, and perioperative blood transfusion. Among laparoscopic cases, independent predictors of SSI included only preoperative leukocytosis and overweight. For patients with deep or organ space SSI, significant predictors included hypoalbuminemia, preoperative weight loss, respiratory comorbidities, MSCS greater than 4, and perioperative blood transfusion for laparotomy and only preoperative leukocytosis for minimally invasive surgery. Surgical site infection was associated with longer mean hospital stay and higher rate of reoperation, sepsis, and wound dehiscence. Surgical site infection was not associated with increased risk of acute renal failure or 30-day mortality. These findings were consistent in subset of patients with deep or organ space SSI.

Conclusions Seven percent of patients undergoing laparotomy for gynecologic malignancy developed SSI. Surgical site infection is associated with longer hospital stay and more than 5-fold increased risk of reoperation. In this study, we identified several risk factors for developing SSI among gynecologic cancer patients. These findings may contribute toward identification of patients at risk for SSI and the development of strategies to reduce SSI rate and potentially reduce the cost of care in gynecologic cancer surgery.

*Division of Gynecologic Oncology, Ob/Gyn and Women’s Health Institute, Cleveland Clinic, Cleveland, OH; and †Department of Biostatistics, University of Washington, Seattle, WA.

Address correspondence and reprint requests to Haider Mahdi, MD, Division of Gynecologic Oncology, Ob/Gyn and Women’s Health Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195. E- mail:

The authors declare no conflicts of interest.

Received October 17, 2013

Accepted February 18, 2014

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.