Risk factors for surgical site infection in patients after hysterectomy: a systematic review and meta-analysis.

BACKGROUND

The reported incidence rates of surgical site infection (SSI) following hysterectomy range from 2% to 21%.

AIM

To conduct a meta-analysis to determine the risk of post-hysterectomy infection and to assess risk factors for post-hysterectomy SSI.

METHODS

A systematic search was made in PubMed, Embase, and the Cochrane Library, and reference lists were manually searched from previous systematic reviews and meta-analyses. A random effects model was used to estimate the combined odds ratio values.

FINDINGS

A total of 88,735 potential articles in the database search met the inclusion criteria. After the titles, abstracts, and full texts were reviewed, 23 articles were included in the final analysis. The 23 articles included 681,695 patients who underwent hysterectomy. High-quality (Class I) evidence showed that abdominal hysterectomy (odds ratio: 4.17; 95% confidence interval: 3.42-5.07), vaginal hysterectomy (1.22; 1.05-1.42), obesity (body mass index ≥30 kg/m) (1.56; 1.40-1.75), gynaecological cancer (1.49; 1.30-1.72), operative time ≥160 min (1.58; 1.36-1.84), diabetes (1.57; 1.23-2.00), and smoking (1.41; 1.14-1.74) were associated with a greater risk of infection. The meta-analysis revealed no associations of age or intraoperative blood loss ≥500 mL with infection.

CONCLUSION

This meta-analysis identified seven significant risk factors for post-hysterectomy infection, including abdominal hysterectomy, vaginal hysterectomy, obesity, gynaecological cancer, operative time, diabetes, and smoking. These findings can help identify patients who have a higher risk of infection after hysterectomy so that appropriate measures can be implemented to improve the prognosis of these patients.