P19 – Total Abdominal Hysterectomy: Reduced Risk of Surgical Site Infection Associated with Robotic and Laparoscopic Technique

Author(s):
Kristin Colling, James Glover, Melissa Geller, Catherine Statz, Gregory Beilman, University of Minnesota

Background: Total abdominal hysterectomy (TAH) is one of the most common procedures performed in the US. New techniques utilizing laparoscopic and robotic technology are becoming increasingly common. It is unknown if these minimally invasive surgical (MIS) techniques alter the risk of surgical site infections (SSI).

Hypothesis: MIS techniques are associated with decreased SSI following TAH.

Methods: We performed a retrospective review of all TAH performed at our institution January 2011 through June 2013. ICD-9 codes and chart review were used to identify patients undergoing TAH by open, laparoscopic or robotic approach and to identify patients that subsequently developed SSI. Univariate analysis was performed with Chi-squared and ANOVA tests. Logistic regression was used to perform multivariate analysis.

Results: During this time, 986 patients underwent TAH: 433 with open technique (44%), 116 laparoscopic (12%), 407 robotic (41%) and 30 cases converted to open (3%). Patients undergoing laparoscopic TAH were significantly younger and had lower BMI and ASA score than those undergoing open or robotic TAH. There were no significant differences in patients undergoing open and robotic TAH. Open TAH was associated with significantly longer hospital stay than laparoscopic or robotic TAH (5.1, 1.7 and 1.6 days respectively; p<0.0001). The rate of SSI after any TAH was 4%. Significantly more SSI occurred in open cases (7%) than laparoscopic (0%) or robotic (2%) (p<0.0001). Cases converted to open also had an increased rate of SSI (13%). In univariate analysis: open technique, ASA >3, wound class of III/IV and obesity were all associated with increased risk of SSI. In multivariate analysis: wound class of III/IV, ASA score of >3 and open technique were all independently associated with increased risk of SSI.

Conclusions: Laparoscopic and robotic TAH were associated with a significantly lower risk of SSI and shorter hospital stay. ASA score and wound class were also independent risk factors for SSI.