LAUSR

STUDY OBJECTIVES To compare 30-day incidence of deep/organ-space and/or superficial incisional surgical site infections (SSI) by sub-type of laparoscopic hysterectomy and to report on additional risk factors for SSI following laparoscopic hysterectomy. DESIGN Retrospective cohort study SETTING: American College of Surgeons National Surgical Quality Improvement Program Database PATIENTS: Women undergoing laparoscopic hysterectomy from 2012 to 2014 INTERVENTIONS: Women were stratified into 3 groups by type of hysterectomy: total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy (LAVH), and laparoscopic supra-cervical hysterectomy (LSCH). Demographic and clinical characteristics were compared for the three groups using Kruskal-Wallis or 1-way analysis of variance where appropriate for continuous variables, and Chi-squared or Fisher's exact test for categorical variables. Post-hoc analyses were performed for multiple comparisons. Univariate analyses to examine the association with SSI were performed using student's t-test or Wilcoxon rank sum test as appropriate for continuous variables, and Chi-squared test or Fisher's exact test as appropriate for categorical variables. Significant variables on univariate analysis were included in a stepwise backward multivariable logistic regression to identify independent risk factors for SSI. MEASUREMENTS AND MAIN RESULTS 46,755 women underwent laparoscopic hysterectomy. The majority were classified as TLH (26,009, 56%), followed by LAVH (13,884, 30%), and LSCH (6,862, 14%). The overall rate of 30-day deep/organ-space SSI was 1.8%(n=445). 30-day deep/organ-space SSI was lower in women who had LSCH (0.6%) compared to TLH (1.0%) or LAVH (1.1%) (p=0.001), but there was no difference in the incidence of superficial incisional SSI (0.8%, 0.8%, and 0.8% for TLH, LAVH, and LSCH respectively (p= 0.75). On multivariate regression analysis, LSCH remained independently associated with a decreased risk of deep/organ-space SSI (aOR 0.60, 0.43-0.84; p=0.003). Additionally, relative to women who were discharged on the same day, women admitted for >24 hours had 2-fold increased odds of deep/organ-space SSI. Asian race, smoking, perioperative transfusion, dirty/infected cases, and ASA class 3 were associated with increased odds for deep/organ-space SSI. Length of stay >24 hours, Native Hawaiian/Pacific islander race was associated with increased the odds of superficial incisional SSI. CONCLUSIONS Laparoscopic supra-cervical hysterectomy is associated with a decreased risk of deep organ-space SSI compared to other sub-types of laparoscopic hysterectomy. Same-day discharge after laparoscopic hysterectomy is associated with decreased odds of SSI.