Factors associated with surgical site infection following abdominal hysterectomy: a five-year cohort study

Abstract

Background and Objectives: Surgical site infection (SSI) is an important complication following hysterectomy. Given the rising antimicrobial resistance in Iran, this multi-year cohort study aimed to identify independent predictors of SSI after hysterectomy.
Materials and Methods: This retrospective cohort study included patients undergoing total abdominal hysterectomy (2019-2024). Independent risk factors were identified via multivariable binary logistic regression. Model performance was validated using receiver operating characteristic (ROC) curve analysis. Continuous variable cut-off points were determined using the Youden index.
Results: Among 690 patients, the SSI rate was 5.2%. Multivariable analysis identified obesity (BMI ≥ 30 kg/m²) (Adjusted Odds Ratio [aOR]: 4.11; 95% CI: 1.81–9.32; p < 0.001) and operative duration (aOR: 1.02 per minute; p < 0.001) as the strongest independent predictors. ROC analysis demonstrated excellent discrimination (AUC = 0.88). Infection risk increased critically when surgery exceeded 180 minutes or in obese patients. Preoperative non-standard antibiotic prophylaxis consisting solely of clindamycin was associated with a 7.5-fold increased SSI risk (P=.006). Microbiological analysis revealed a 30.6% prevalence of multidrug-resistant and ESBL-producing bacteria.
Conclusion: Obesity and prolonged operative time are independent predictors of SSI. We recommend weight-based dosing, strict intraoperative re-dosing during prolonged procedures, and mandatory antimicrobial stewardship to mitigate risks associated with non-standard prophylaxis.