Surgical Site Infection in Women Undergoing Surgery for Gynecologic Cancer

Abstract

Seven percent of patients undergoing laparotomy for gynecologic malignancy developed SSI. Surgical site infection is associated with longer hospital stay and more than 5-fold increased risk of reoperation. In this study, we identified several risk factors for developing SSI among gynecologic cancer patients. These findings may contribute toward identification of patients at risk for SSI and the development of strategies to reduce SSI rate and potentially reduce the cost of care in gynecologic cancer surgery.

Surgical site infection after primary surgery for epithelial ovarian cancer: Predictors and impact on survival

“…Other studies of EOC PS have found an equivocal or weakly positive association between surgical complexity and wider array of postoperative complications not just limited to SSI, but also thromboembolic events, sepsis, or indication for readmission or return to operating room within 30 days [17,23]. Aside from surgical complexity, the only other intraoperative variable identified by Mahdi et al that was significantly associated with development of SSIs was perioperative transfusion of greater than 4 units of packed red blood cells [10]. While transfusion of blood products was associated with all SSI and organ/space SSI in univariable analyses in our study, it was not significant in multivariable analyses.…”

“…In our study, 1 in 9 women developed an SSI. Rates previously reported have ranged from 6 to 15% among women undergoing gynecologic cancer operations [8][9][10]19]. SSI in ovarian cancer has previously been shown to be associated with increased postoperative mortality, increased risk of readmission, and longer TTC [8,9,19].…”

“…In their study defining risk factors for SSI among women undergoing laparotomy for cervical, endometrial, or ovarian cancer, Mahdi et al identified increasing surgical complexity as an independent risk factor for SSI [10]. Other studies of EOC PS have found an equivocal or weakly positive association between surgical complexity and wider array of postoperative complications not just limited to SSI, but also thromboembolic events, sepsis, or indication for readmission or return to operating room within 30 days [17,23].…”

“…We also found an association between increasing BMI and superficial SSI. Obesity, whether defined by BMI or body fat percentage, is a well-recognized risk factor for SSI in women undergoing colorectal surgery, hysterectomy, or primary surgery for various gynecologic malignancies [10,12,25]. Additionally, obesity has been associated with increased 30-day morbidity as well as 90-day mortality in women with EOC following PS [26].…”

“…The rate of SSI following primary surgery for EOC has been estimated to be between 6 and 15% [8][9][10]. A study of 2434 women who underwent primary surgery for EOC found that SSIs were second only to pulmonary failure as the most common cause of postoperative mortality, directly contributing to 15% and 18% of deaths, respectively [9].…”