Evaluation of Perioperative Factors Contributing to Organ Space Surgical Site Infection After Minimally Invasive Hysterectomy [ID: 1374862]

Abstract

INTRODUCTION: Postoperative organ space surgical site infection (oSSI), commonly referred to as pelvic abscess, is a clinically impactful complication after hysterectomy. Although more common in open hysterectomies, oSSIs occur in minimally invasive hysterectomy (MIH), contributing to morbidity. In the current study, we evaluate perioperative factors contributing to development of oSSIs in patients undergoing MIH. METHODS: From 2016 to 2022, a multicenter retrospective analysis of patients undergoing MIH was conducted. Patient characteristics, preexisting conditions, surgical history, intraoperative factors, and type of MIH were evaluated to determine factors contributing to the development of oSSI. RESULTS: One thousand one hundred eighty-nine patients underwent MIH. 28 patient (2.4%) developed oSSI. There was no difference in age or body mass index between groups (P>.05) and no difference in the incidence of oSSI based on type of MIH (P=.832). Patients with endometriosis were more likely to develop oSSI (4.9% versus 2.0%, P=.045, odds ratio [OR] 2.49, 95% CI 1.98–6.25). A diagnosis of cancer did not affect oSSI (3.9% versus 2.1%, P=.162, OR 1.90, 95% CI 0.76–4.78). History of diabetes, hypertension, cesarean delivery, prior laparoscopy, prior laparotomy, smoking, or obesity did not affect the incidence of oSSI (P<.05). Patients developing oSSI had a greater mean intraoperative estimated blood loss (EBL) (233.55 cc versus 94.3 cc, P<.001), greater mean length of stay (LOS) (2.4 versus 0.9 days, P<.001), higher incidence of post-operative ileus (15.8% versus 0.7%, P<.001) and blood transfusion (34.6% versus 1.0%, P<.001). CONCLUSION: Development of oSSI is associated with preexisting endometriosis and greater intraoperative EBL. Development of oSSI was associated with greater LOS, postoperative ileus, and blood transfusions. Attention to hemostasis may reduce rates of oSSI.