2529 Increased Surgical Site Infections in Robotic Hysterectomies in a Large Health System

Abstract

Study Objective To describe cases of surgical site infection (SSI) after hysterectomy in a large health system and investigate adherence to infection prevention guidelines Design Retrospective observational study Setting 6 hospitals in New York, both community and academic centers Patients or Participants Patients with surgical site infections as defined by CDC after hysterectomy in 2016 and 2017 Interventions n/a Measurements and Main Results Available data from 6 hospitals across a large health system in New York were analyzed. A total of 4589 inpatient open, robotic, and laparoscopic hysterectomies were performed in 2016 and 2017 of which 48 cases of surgical site infection were identified and reviewed. Overall SSI incidence was found to be 1.05%. Mean age of SSI cases was 53.5, and mean BMI 33.7. Among the SSI cases, 20 (41.7%) originated from a robotic approach, 1 (2.1%) straight laparoscopic, and 27 (56.2%) were open. This gave an SSI incidence of 1.98% for robotic, 0.13% for straight laparoscopic, and 0.97% for open approach. 41 (85.4%) SSI cases had total hysterectomies vs 7 (14.6%) supracervical. 34 (70.8%) of cases had a history of prior abdominal surgery. The most common infection type was intraabdominal at 19 cases (39.6%). Incisional infections accounted for 11 cases (22.9%), and vaginal cuff infection accounted for 4 (8.3%). The most common pathogens encountered were bacteroides fragilis (16.2%) and staphylococcus aureus (16.2%). Of 10 cases that used second-line antibiotics, 70% did not adhere to system protocol for dosing or antibiotic choice. Conclusion A review of cases reveals robotic hysterectomies as having the largest rate of SSI in the 6 hospitals examined at 1.98% as compared to laparoscopic hysterectomies with an SSI rate of 0.13% over 2 years. Further research is needed to validate these findings over time and geographic location, and examine reasons why robotic surgery may confirm a higher infection rate than laparoscopic in these locations.