Prevention of Surgical Site Infections in Gynecologic Surgery: A Review of Risk Factors and Recommendations

Risk factor evaluation and performance improvement for surgical site infections in patients undergoing abdominal hysterectomy at a large academic safety net hospital

OBJECTIVE

To identify Surgical Site Infection (SSI) risk factors for abdominal hysterectomy patients and report the results of a performance improvement initiative.

DESIGN

Retrospective case-control.

SETTING

Parkland Hospital, an 882-bed academic, safety-net, tertiary referral center and a level 1 trauma center serving a diverse population of primarily uninsured patients in North Texas.

PARTICIPANTS

Patients over 18 who underwent abdominal hysterectomy and were diagnosed with SSIs within 30 days of surgery between 2019 and 2021.

METHODS

Cases were matched to controls from the same or closest calendar month in a 1:2 ratio. Chart review of electronic medical records (EMR) was performed comparing variables using Pearson's χ2 test for categorical variables and Student's t-test for continuous variables followed by logistic regression for multivariate analysis. Upon identifying vaginal preparation technique as an area of improvement while investigating SSI bundle compliance, we implemented an OR staff training intervention.

RESULTS

Diabetes was identified as a significant risk factor while Hispanic or Latino ethnicity was associated with significantly lower rates of infection. Most organisms identified were enteric pathogens. Following the intervention, Parkland's deep and organ-space Standardized Infection Ratio (SIR) decreased from 1.46 in 2021 to 0.519 for the rolling 12 months as of June 2024.

CONCLUSIONS

Our multidisciplinary intervention improving the quality and consistency of pre-operative vaginal preparation was associated with a reduction in abdominal hysterectomy SSI.

The Role of Preoperative Antibiotics in Surgical Site Infection (SSI) Rate after Class I/Clean Gynaecologic Surgery at an Academic Safety Net Hospital

OBJECTIVES

Examine whether preoperative antibiotics in class I/clean abdominal gynaecologic surgery decrease the incidence of surgical site infections (SSI).

METHODS

Retrospective cohort study at academic safety net hospital of patients undergoing class I laparoscopic or open gynaecologic surgery between November 2013 and September 2017. Performance improvement initiative to administer preoperative antibiotics to all surgical patients starting July 2016.

RESULTS

In total, 510 patients were included: 283 in the antibiotic group and 227 in the no-antibiotic group.

PRIMARY OUTCOME

incidence of SSI. Baseline characteristics were similar between groups once balanced by propensity score method. In unweighted analysis, incidence of SSI decreased from 9.3% (21/227) in the no-antibiotics group to 4.9% (14/283) in antibiotics group, but this was not statistically significant (odds ratio (OR) 0.51 CI 0.25-1.03, P = 0.0598). Following of inverse probability of treatment weighting adjustments in weighted analysis, incidence of SSI was found to be significantly lower in patients who received antibiotics compared to patients who did not receive antibiotics across entry types (4.6% vs. 9.8%, OR 0.45; CI 0.22-0.90, P = 0.023). Weighted analysis demonstrated in the exploratory laparotomy group patients who received antibiotics had a lower incidence of SSI compared to patients who did not receive antibiotics (5.1% vs. 18.7%, OR 0.23; CI 0.08-0.68, P = 0.008). In the laparoscopy group, there was no difference between groups (4.4% vs. 5.4%, OR 0.81; CI 0.3-2.16, P = 0.675).

CONCLUSIONS

There is limited literature on SSI prevention/preoperative antibiotic use in class I gynaecologic surgeries. This study demonstrates antibiotics in class I procedures decrease SSI rates, specifically in open procedures. There was a lack of demonstrated benefit in laparoscopy.

Complications in gynecological surgeries in Ukraine: results a multicenter study

OBJECTIVE

. Aim: To analyze the complications during gynecologic surgery procedures and identify possible risk factors associated with this type of surgery in Ukraine.

PATIENTS AND METHODS

Materials and Methods: We conducted a multicenter, retrospective cohort study in tertiary care hospitals from 12 regions of Ukraine from January, 2021, to December, 2023. The study included women who underwent gynecologic surgery at these hospitals. Postoperative complications are defined by Clavien-Dindo classification.

RESULTS

Results: A total of 13,937 women were included in our study. The overall prevalence of 30-day complications was 13.9%. The most frequently postoperative complication types were surgical site infections, hemorrhage, urinary tract infection, bowel injury, urinary tract injury, and bladder injury. Age 60 years or older (adjusted odds ratio (aOR 1.81), BMI ≥30 kg/m2 (aOR 1.78), diabetes mellitus (aOR 1.45), procedures for gynecologic cancer (aOR 2.58), prior pelvic surgery (aOR 1.61), emergency procedure (aOR 1.83), ASA-physical status class 5 vs. 1 or 2 (aOR 4.31), operative time greater than 3 hours vs. less than 1 hour (aOR 2.92), wound class 4 vs. 1 (aOR 4.28), and open abdominal approach for surgery vs. laparoscopic procedure (aOR 2.65) were significantly associated with postoperative complications.

CONCLUSION

Conclusions: This study found a high prevalence of complications rate in gynecological surgery varied widely depending on the approach and type of procedure. Risk factors for complications are age, obesity, diabetes, procedures for gynecologic cancer, prior pelvic surgery, emergency procedure, open abdominal surgery, ASA-physical status, duration of surgery, and wound class.

From Prevention to Management: Understanding Postoperative Infections in Gynaecology

This narrative review examines the multifaceted realm of postoperative infections in gynaecology, addressing their significance, types, risk factors, prevention, management, and emerging trends. Postoperative infections, encompassing surgical site infections, urinary tract infections, and pelvic inflammatory disease, pose considerable challenges in patient care, warranting comprehensive exploration. Strategies for prevention include preoperative patient assessment, antimicrobial prophylaxis, and aseptic techniques. Intraoperative measures encompass infection control and instrument sterilization, while postoperative care involves wound management and early infection detection. Diagnostic tools, including blood tests, imaging, and microbiological cultures, aid in timely identification. Management strategies encompass antibiotic therapy, surgical interventions, supportive care, and addressing complications. The review underscores the necessity of personalized approaches, multidisciplinary collaboration, and innovative technologies in future infection management. It calls for ongoing research, heightened awareness, and meticulous care to minimize the impact of postoperative infections and optimize patient outcomes.