Surgical site infections after hysterectomy among HIV-infected women in the HAART era: A single institution's experience from 1999-2012

Jenell S. Coleman Fennell, Isabel Green, Stacey Scheib, Catherine Sewell, Judy M Lee, Jean Anderson

Research output: Contribution to journalArticle

Abstract

Objective We sought to determine risk factors associated with surgical site infection (SSI) among a cohort of human immunodeficiency virus (HIV)-infected women undergoing hysterectomy during the era of highly active antiretroviral therapy. Study Design This is a retrospective study of HIV-infected women who underwent a hysterectomy for benign indications at a tertiary care center. Electronic medical records were reviewed from January 1999 through December 2012. SSI was defined using Centers for Disease Control and Prevention criteria. Results There were 77 HIV-infected women who underwent a hysterectomy: 47 (61%) were abdominal; 16 (21%) were laparoscopic or robot-assisted; and 14 (18%) were vaginal. Acquired immune deficiency syndrome was diagnosed in 58% of patients, and 75% of patients self-reported use of highly active antiretroviral therapy at the time of surgery. There were 17 (22%) SSIs; 5 (29%) superficial incisional wound infections, 3 (18%) vaginal cuff cellulitis, and 9 (53%) pelvic abscesses were diagnosed. After multivariable logistic regression, preoperative albumin level (adjusted odds ratio [aOR], 0.14; 95% confidence interval [CI], 0.02-0.86) and minimally invasive hysterectomy (aOR, 0.16; 95% CI, 0.03-0.84) were associated with decreased SSI. Preoperative absolute CD4 count was not associated with SSI (aOR, 0.99; 95% CI, 0.99-1). Conclusion Low preoperative serum albumin levels and abdominal hysterectomy are associated with increased risk of SSIs in HIV-infected women.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Volume210
Issue number2
DOIs
StatePublished - Feb 2014

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Surgical Wound Infection
Highly Active Antiretroviral Therapy
Hysterectomy
HIV
Odds Ratio
Confidence Intervals
Cellulitis
Electronic Health Records
Wound Infection
Centers for Disease Control and Prevention (U.S.)
CD4 Lymphocyte Count
Tertiary Care Centers
Serum Albumin
Abscess
Albumins
Acquired Immunodeficiency Syndrome
Retrospective Studies
Logistic Models

Keywords

  • CD4 count
  • human immunodeficiency virus
  • hysterectomy
  • preoperative albumin
  • surgical site infection

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Medicine(all)

Cite this

@article{9fc2738f4176456ca901255a62aa8f63,
title = "Surgical site infections after hysterectomy among HIV-infected women in the HAART era: A single institution's experience from 1999-2012",
abstract = "Objective We sought to determine risk factors associated with surgical site infection (SSI) among a cohort of human immunodeficiency virus (HIV)-infected women undergoing hysterectomy during the era of highly active antiretroviral therapy. Study Design This is a retrospective study of HIV-infected women who underwent a hysterectomy for benign indications at a tertiary care center. Electronic medical records were reviewed from January 1999 through December 2012. SSI was defined using Centers for Disease Control and Prevention criteria. Results There were 77 HIV-infected women who underwent a hysterectomy: 47 (61{\%}) were abdominal; 16 (21{\%}) were laparoscopic or robot-assisted; and 14 (18{\%}) were vaginal. Acquired immune deficiency syndrome was diagnosed in 58{\%} of patients, and 75{\%} of patients self-reported use of highly active antiretroviral therapy at the time of surgery. There were 17 (22{\%}) SSIs; 5 (29{\%}) superficial incisional wound infections, 3 (18{\%}) vaginal cuff cellulitis, and 9 (53{\%}) pelvic abscesses were diagnosed. After multivariable logistic regression, preoperative albumin level (adjusted odds ratio [aOR], 0.14; 95{\%} confidence interval [CI], 0.02-0.86) and minimally invasive hysterectomy (aOR, 0.16; 95{\%} CI, 0.03-0.84) were associated with decreased SSI. Preoperative absolute CD4 count was not associated with SSI (aOR, 0.99; 95{\%} CI, 0.99-1). Conclusion Low preoperative serum albumin levels and abdominal hysterectomy are associated with increased risk of SSIs in HIV-infected women.",
keywords = "CD4 count, human immunodeficiency virus, hysterectomy, preoperative albumin, surgical site infection",
author = "{Coleman Fennell}, {Jenell S.} and Isabel Green and Stacey Scheib and Catherine Sewell and Lee, {Judy M} and Jean Anderson",
year = "2014",
month = "2",
doi = "10.1016/j.ajog.2013.08.037",
language = "English (US)",
volume = "210",
journal = "American Journal of Obstetrics and Gynecology",
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T1 - Surgical site infections after hysterectomy among HIV-infected women in the HAART era

T2 - A single institution's experience from 1999-2012

AU - Coleman Fennell, Jenell S.

AU - Green, Isabel

AU - Scheib, Stacey

AU - Sewell, Catherine

AU - Lee, Judy M

AU - Anderson, Jean

PY - 2014/2

Y1 - 2014/2

N2 - Objective We sought to determine risk factors associated with surgical site infection (SSI) among a cohort of human immunodeficiency virus (HIV)-infected women undergoing hysterectomy during the era of highly active antiretroviral therapy. Study Design This is a retrospective study of HIV-infected women who underwent a hysterectomy for benign indications at a tertiary care center. Electronic medical records were reviewed from January 1999 through December 2012. SSI was defined using Centers for Disease Control and Prevention criteria. Results There were 77 HIV-infected women who underwent a hysterectomy: 47 (61%) were abdominal; 16 (21%) were laparoscopic or robot-assisted; and 14 (18%) were vaginal. Acquired immune deficiency syndrome was diagnosed in 58% of patients, and 75% of patients self-reported use of highly active antiretroviral therapy at the time of surgery. There were 17 (22%) SSIs; 5 (29%) superficial incisional wound infections, 3 (18%) vaginal cuff cellulitis, and 9 (53%) pelvic abscesses were diagnosed. After multivariable logistic regression, preoperative albumin level (adjusted odds ratio [aOR], 0.14; 95% confidence interval [CI], 0.02-0.86) and minimally invasive hysterectomy (aOR, 0.16; 95% CI, 0.03-0.84) were associated with decreased SSI. Preoperative absolute CD4 count was not associated with SSI (aOR, 0.99; 95% CI, 0.99-1). Conclusion Low preoperative serum albumin levels and abdominal hysterectomy are associated with increased risk of SSIs in HIV-infected women.

AB - Objective We sought to determine risk factors associated with surgical site infection (SSI) among a cohort of human immunodeficiency virus (HIV)-infected women undergoing hysterectomy during the era of highly active antiretroviral therapy. Study Design This is a retrospective study of HIV-infected women who underwent a hysterectomy for benign indications at a tertiary care center. Electronic medical records were reviewed from January 1999 through December 2012. SSI was defined using Centers for Disease Control and Prevention criteria. Results There were 77 HIV-infected women who underwent a hysterectomy: 47 (61%) were abdominal; 16 (21%) were laparoscopic or robot-assisted; and 14 (18%) were vaginal. Acquired immune deficiency syndrome was diagnosed in 58% of patients, and 75% of patients self-reported use of highly active antiretroviral therapy at the time of surgery. There were 17 (22%) SSIs; 5 (29%) superficial incisional wound infections, 3 (18%) vaginal cuff cellulitis, and 9 (53%) pelvic abscesses were diagnosed. After multivariable logistic regression, preoperative albumin level (adjusted odds ratio [aOR], 0.14; 95% confidence interval [CI], 0.02-0.86) and minimally invasive hysterectomy (aOR, 0.16; 95% CI, 0.03-0.84) were associated with decreased SSI. Preoperative absolute CD4 count was not associated with SSI (aOR, 0.99; 95% CI, 0.99-1). Conclusion Low preoperative serum albumin levels and abdominal hysterectomy are associated with increased risk of SSIs in HIV-infected women.

KW - CD4 count

KW - human immunodeficiency virus

KW - hysterectomy

KW - preoperative albumin

KW - surgical site infection

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