The purpose of this study was to examine the relationship between the use of a strategy for abdominal closure and the occurrence of surgical site infection (SSI) in gynecologic oncology patients undergoing abdominal hysterectomy. Patients who had a total abdominal hysterectomy performed by gynecologic oncologists at a tertiary care facility between January 1, 2015, and December 31, 2019, were identified using Current Procedural Terminology CPT codes, and were then sorted into groups based on whether or not the abdominal closure strategy was used. Researchers collected data on demographic, operative, and pathologic factors. For categorical data, Fisher’s exact and Chi-squared tests were used; logistic regression and student t-tests were used for continuous variables. Multiple logistic regression was utilized to investigate the associations between closure protocol utilization, SSI onset, and other variables. A total of 739 patients were enrolled in the study (n=393 pre-implementation, n=346 post-implementation of the abdominal closure protocol,). The ASA scores, body mass indexes, diabetes rates, and smoking prevalences of the two groups were similar at the outset (P values ranged from 0.14 to 0.94). Within 30 days after surgery, the rate of SSI was 5.9% (23/393), but it was 8.1% (28/346) in the abdominal closure protocol group (P=0.25). Univariate analysis found associations between SSI and body mass index (BMI) greater than 40, diabetes, colon resection, acute physiology and chronic health evaluation (ASA) score of 3 or 4, hypertension, and the presence of a contaminated wound (uOR 2.31-4.09). Multivariate analysis confirmed the continued independence of pre-existing risk factors (aOR 2.27-2.99; 95% CI 0.79-2.59; closure protocol not significant) for having a body mass index (BMI) over 40, diabetes, and colon resection. No at-risk populations benefited from the wrap-up procedure. Patients undergoing TAH from a gynecologic oncologist found that the abdominal closure technique alone did not lower the risk of SSI.

Source: sciencedirect.com/science/article/abs/pii/S009082582200261X