68: Surgical site infection after laparoscopic hysterectomy

Abstract

To compare 30-day risk of deep/organ space and superficial incisional surgical site infections (SSI) by sub-type of laparoscopic hysterectomy. To report on additional risk factors for SSI following laparoscopic hysterectomy. Using the American College of Surgeons National Surgical Quality Improvement Program’s Database, we identified women undergoing laparoscopic hysterectomy between 2012-2014 using CPT codes. Women were stratified into 3 groups by type of hysterectomy: total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy (LAVH), and laparoscopic supracervical hysterectomy (LSCH). Group comparisons were made using ANOVA and X2 test. Univariate analysis was performed using Student’s t-test, X2 test or Fisher’s exact test. Significant variables on univariate analysis were included in a stepwise backward multivariable logistic regression to identify independent risk factors for SSI. A total of 52,786 women were included. Mean (±SD) age and BMI were 49 ± 12years and 31 ± 8kg/m2; 74% were white. There were 31,070 (59%) hysterectomies classified as TLH, 14,796 (28%) were LAVH, and 6,920 (13%) were LSCH. Mean operative times were shortest for LAVH, and longest for LSCH (130 ± 63 mins and 154 ± 79 mins, respectively; p < 0.001). The 30-day deep/organ space SSI was lower for LSCH (0.6%) than for TLH (1.0%) or LAVH (1.1%) (p = 0.001), but there was no difference in occurrence of superficial incisional SSI: 0.8%, 0.8%, and 0.8% for TLH, LAVH, and LSCH, respectively (p=0.54). On univariate analysis, type of hysterectomy, increasing age, race, smoking, diabetes, preoperative steroid use, dialysis, gynecologic malignancy, ASA class, operative time, peri-operative transfusion, hospital length of stay and wound classification were associated with deep/organ space SSI. On multivariate analysis after controlling for confounders, LSCH remained independently associated with a decreased risk of deep/organ space SSI (aOR 0.59, 0.42-0.83). Conversely, relative to women who were discharged within 24hrs, women admitted for greater than 1 day had a 2-fold increase in deep/organ space SSI (aOR 2.13 (1.56-2.91). Asian race (aOR 1.89, 1.28-2.77), smoking (aOR, 1.45, 1.18-1.79), gynecologic malignancy (aOR, 1.42, 1.05-1.91), perioperative transfusion (aOR 1.94, 1.26-2.99), preoperative steroid use (aOR 1.83, 1.08-3.10), dirty/infected cases (aOR 26.04, 7.31-92.73), and preoperative dialysis (aOR 4.11, 1.20-14.06), were independently associated with increased odds for deep/organ space SSI. Smoking (aOR 1.29, 1.02-1.65) and length of stay greater than 1 day (aOR 1.62, 1.16-2.25) increased the risk of superficial incisional SSI. Laparoscopic supracervical hysterectomy is associated with a decreased risk of deep/organ space SSI compared to other sub-types of laparoscopic hysterectomy. Same-day discharge is protective against SSI.