Pop-Vicas et al reported risk factors for surgical site infections following hysterectomy at a tertiary care center. These can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Wisconsin and William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin.

Patient selection: high prevalence of gynecologic malignancies


Outcome: superficial, deep or organ space infection within 30 days of surgery


Risk factor from multivariate analysis:

(1) duration of surgery


Additional risk factors from bivariate analysis:

(1) obesity

(2) higher Charlson comorbidity score

(3) immunosuppression

(4) ASA Grade >= 3

(5) history of surgery within the past 60 days

(6) antibiotic prophylaxis with clindamycin and gentamicin

(7) surgery involving the omentum or gastrointestinal tract

(8) >= 4 surgeons in the operating room

(9) greater blood loss

(10) >= 7 catheters or invasive devices when in the operating room

(11) greater length of the hospital stay



Operations with a long duration tended to be for malignancy and to involve additional risk factors 7, 8, and 10.

Greater blood loss may be associated with blood transfusion.


Protective factors from bivariate analysis:

(1) laparoscopic or robotic surgery (versus open)

(2) antibiotic prophylaxis with cefazolin


All patients received preoperative antibiotic prophylaxis.

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