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

Published online by Cambridge University Press:  02 January 2015

Margaret A. Olsen ,
James Higham-Kessler ,
Deborah S. Yokoe ,
Anne M. Butler ,
Johanna Vostok ,
Kurt B. Stevenson ,
Yosef Khan ,
Victoria J. Fraser  and
Prevention Epicenter Program, Centers for Disease Control and Prevention
Margaret A. Olsen*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
James Higham-Kessler
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Deborah S. Yokoe
Affiliation:
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Anne M. Butler
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Johanna Vostok
Affiliation:
Harvard Pilgrim Health Care, Boston, Massachusetts
Kurt B. Stevenson
Affiliation:
Department of Clinical Epidemiology, Ohio State University Medical Center, Columbus, Ohio Division of Infectious Diseases, College of Medicine, Ohio State University, Columbus, Ohio
Yosef Khan
Affiliation:
Department of Clinical Epidemiology, Ohio State University Medical Center, Columbus, Ohio Division of Infectious Diseases, College of Medicine, Ohio State University, Columbus, Ohio
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
*
Division of Infectious Diseases, Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63110-1093 ([email protected])
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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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 11 , November 2009 , pp. 1077 - 1083
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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