Open surgery, prolonged procedures, obesity, diabetes, and younger age are associated with higher risk of infection following abdominal hysterectomy

Arlington, Va., March 30, 2023 – 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) following these procedures, including open surgery, obesity, diabetes, gynecological cancer, and age under 45. Published today in the American Journal of Infection Control (AJIC), the data can help inform surgical and clinical decisions to reduce post-operative infections.

“Improved understanding of patient-related, clinical, and surgical factors associated with SSI in hysterectomy, a common surgical procedure in the United States, could help to reduce infections and improve risk models,” said Boldtsetseg Tserenpuntsag, DrPH, Director – Data Unit, Bureau of Healthcare Associated Infections, New York State Department of Health, and the lead author on the published study. “As far as we know, our findings are derived from the most comprehensive dataset to date, making them more generalizable as compared to previous studies on this subject.”

SSIs are infections that occur at a surgical incision site within 30 days after the incision is made. According to the Centers for Disease Control and Prevention, SSI accounts for 20% of all healthcare-associated infections (HAIs) and is associated with a 2-to 11-fold increase in the risk of mortality. SSI is also the most costly type of HAI with an estimated annual cost of $3.3 billion.

To identify the 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 at all acute care hospitals in New York State (166). They augmented these data with diagnosis codes available in administrative data.

Among the 66,001 procedures the researchers analyzed, 1,093 (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 an SSI:

• Age under 45: Adjusted odds ratio (AOR) of 1.65 (age under 35) and 1.21 (age 35-44)
• Open laparotomic approach (i.e., not laparoscopic): AOR of 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 of 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 meaningfully to our understanding of SSI, and should provide valuable information to enhance surgical planning and thereby help prevent post-surgical infections,” said Patricia Jackson, RN, MA, CIC, FAPIC, 2023 APIC president.  

About APIC

Founded in 1972, the Association for Professionals in Infection Control and Epidemiology (APIC) is the leading association for infection preventionists and epidemiologists. With more than 15,000 members, APIC advances the science and practice of infection prevention and control. APIC carries out its mission through research, advocacy, and patient safety; education, credentialing, and certification; and fostering development of the infection prevention and control workforce of the future. Together with our members and partners, we are working toward a safer world through the prevention of infection. Join us and learn more at apic.org.

About AJIC

As the official peer-reviewed journal of APIC, The American Journal of Infection Control (AJIC) is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. Published by Elsevier, AJIC also publishes infection control guidelines from APIC and the CDC. AJIC is included in Index Medicus and CINAHL. Visit AJIC at ajicjournal.org.

NOTE FOR EDITORS

“Risk Factors for Surgical Site Infection after Total Abdominal Hysterectomy, New York State 2015-2018,” by Boldtsetseg Tserenpuntsag, DrPH, and colleagues at the New York State Department of Health was published online in AJIC on March 30, 2023. The article may be found at: https://doi.org/10.1016/j.ajic.2023.01.016

AUTHORS

Boldtsetseg Tserenpuntsag, DrPH (corresponding author: boldtsetseg.tserenpuntsag@health.ny.gov), New York State Department of Health, Albany, New York, USA

Valerie Haley, PhD, New York State Department of Health, Albany, New York, USA

Peggy Ann Hazamy, RN, BSN, CIC (retired), New York State Department of Health, Albany, New York, USA

Antonella Eramo, MS, CIC (retired), New York State Department of Health, Albany, New York, USA

Robin Knab, CLT M (ASCP), CIC, New York State Department of Health, Albany, New York, USA

Marie Tsivitis, MPH, CIC, MT (ASCP), New York State Department of Health, Albany, New York, USA

Ernest Clement, MSN, RN, CIC, New York State Department of Health, Albany, New York, USA

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Media contacts: Liz Garman, egarman@apic.org, 202-365-7421; Aaron Cohen, aaroncohenpr@gmail.com, 301-633-6773