Incidence and Microbiology of Surgical Site Infection Following Hysterectomy at a South African Quaternary Hospital

Background: Data from high-income countries suggest that surgical site infection (SSI) is an important cause of morbidity following hysterectomy, with a reported incidence of 2.7%. SSI is also associated with increased healthcare resource utilization. Reports of SSI following hysterectomy in African settings are rare, limiting our setting-specific understanding of this complication. Objectives: To determine the incidence and microbiology of SSI following hysterectomy at a South African quaternary hospital. Patients and Methods:This is a retrospective cohort study of 563 hysterectomy patients who attended a South African quaternary hospital between 1 January 2012 and 31 July 2016. We collected data on patient age, comorbidity, surgery-related variables, and postoperative length of stay from the hospital’s administrative database and a retrospective chart review. Our study outcome was SSI up to 30 days postoperatively. SSI data was obtained from the hospital’s diagnostic laboratory. We calculated the cumulative incidence of SSI, and also performed descriptive and bivariate statistical analyses. Results: The cumulative incidence of SSI was 2.8%. Patients with SSI had a longer postoperative length of stay (p < 0.001), underwent surgery via the laparotomy approach (p=0.009), or had wound closure with the simple mattress approach (p=0.015). Infection with Pseudomonas aeruginosaor atypical microorganisms was common. Conclusion: SSI contributes to morbidity and increased healthcare resource utilization following hysterectomy in our setting. The decision to choose the approach for hysterectomy should consider the higher risk of SSI associated with the laparotomy approach and interrupted suturing. SSIs with atypical microorganisms present a challenge for patient management in our setting.