Risk factors for surgical site infection following hysterectomy: nine-year experience at a large safety-net hospital network in New York City.

Objective: To identify risk factors for surgical site infections (SSIs) following abdominal hysterectomy in patients cared for in a large urban public hospital system. Design: Retrospective case control study. Setting: Multicenter safety net hospital system. Participants all: Women undergoing hysterectomy from 2015-2023. Methods: Propensity score matching, using Centers for Medicare and Medicaid Services (CMS) risk variables, created control groups. Receiver operating characteristics curves were created using current and augmented risk adjustment variables. Results: There were 6142 hysterectomy surgeries reported during the 9-year time period, with 160 (2.61%) with reportable SSIs. Compared to a matched control group, patients with SSIs were more likely to be of Black race, to have longer duration of surgery, to have open surgery (vs. laparoscopic), and to have received a clindamycin ± gentamicin for surgical prophylaxis. The addition of duration of surgery, endoscopic surgery, and wound class to current CMS risk variables significantly improved the prediction for SSI when all SSIs were included, but did not when patients with superficial SSIs were excluded from analysis. Conclusions: Predicting SSIs following hysterectomy is complex and current CMS risk assessments are overly simplistic. Until more robust and comprehensive risk assessment criteria are developed, use of SSIs following hysterectomy as a quality measure for reimbursement should be reconsidered.