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Surg Infect (Larchmt). 2011 Dec;12(6):491-6. doi: 10.1089/sur.2010.103. Epub 2011 Dec 5.

Beyond core measures: identifying modifiable risk factors for prevention of surgical site infection after elective total abdominal hysterectomy.

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  • 1Department of Internal Medicine, Division of Infectious Diseases, Denver Health Hospital & University of Colorado Health Sciences Center, Denver, Colorado, USA. heather.young@ucdenver.edu

Abstract

BACKGROUND:

Despite adherence to the Centers for Medicare and Medicaid Services (CMS) core measures for preventing surgical site infections (SSI), our institution has a >10% rate of SSI after total abdominal hysterectomy (TAH), higher than the 90(th) percentile for SSI rates published in the 2009 National Healthcare Safety Network report.

METHODS:

A retrospective chart review was performed for patients who underwent elective TAH at a public safety net hospital in Denver from December 30, 2005, to March 9, 2010. The primary outcome was development of SSI within 30 days. A secondary outcome was adherence to CMS core measures.

RESULTS:

A total of 192 patients were included in the analysis, of whom 21 (10.9%) developed SSI. More than 95% had received antibiotics in the 60 min before surgical incision, and >90% received an appropriate antibiotic. Compliance with post-anesthesia care unit normothermia was equivalent in the SSI and non-SSI groups (81.0% vs. 75.2%; p=0.5588). Surgical site infection was associated with obesity (body mass index [BMI]≥30) (15.4% vs. 6.9%; p=0.0609), estimated blood loss≥500 mL (18.5% vs. 8.0%; p=0.0353), and receipt of a blood transfusion (28.6% vs. 10.5%; p=0.0183). In a multiple logistic regression model, obesity marginally increased the risk of SSI (odds ratio [OR] 2.55; 95% confidence interval [CI] 0.94-6.74), whereas blood transfusion was significantly associated with a higher risk of SSI (OR 3.58; 95% CI 1.21-10.62).

CONCLUSIONS:

Blood transfusion was associated with SSI after TAH in our population. As it is a modifiable risk factor, larger multi-center studies are needed to confirm this result and determine appropriate transfusion thresholds.

PMID:
22142313
[PubMed - indexed for MEDLINE]
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