OBJECTIVES : Hysterectomy is a highly prevalent procedure, with more than 30% American women expected to have had the procedure by age 60. Surgical site infection following hysterectomy can result in significant morbidity and cost. This study was thus designed to understand risk of infection types (deep vs superficial vs organ/space) and associated costs for these patients.

METHODS : A retrospective study of patients undergoing hysterectomy between 2014 and 2017 was conducted using IBM® MarketScan® Commercial, Multi-State Medicaid and Medicare Supplemental databases. Patients were categorized by demographic and clinical comorbidities as per the 31 domains of the Elixhauser Comorbidity Index. The outcomes were new diagnoses of infection, categorized as organ/space, deep or superficial within 6 months of hysterectomy. Logistic regression models were developed to evaluate variables associated with infection. Generalized linear regression models were built and adjusted total payments due to infection by category were estimated using least squares means. All payments were adjusted to 2017 consumer price-index.

RESULTS : A total of 150,000 patients were included in the analysis, with mean age 46 years (SD:9.9), 3.4% Medicare and 15.6 % Medicaid (all others commercially insured), 93.0% with no post-hysterectomy infection. Of the 6.99% patients with infection, > 78% were identified within 60 days of hysterectomy. Post-surgical infection included 1.7% organ/space, 0.5% deep, 0.1% organ/space and deep and 4.7% superficial cases. Adjusted total payments in patients with commercial insurance ranged from $61,586 (95% CI: $59,741-$63,488) for superficial to $75,586 (95% CI: $67,892-$84,151) for deep infection in two years following hysterectomy. Key risk factors for infection included cancer with and without metastasis and renal failure.

CONCLUSIONS : Nearly 7% patients suffer from post-hysterectomy infection, of which nearly 33% are affected by deep or organ/space infection. Ongoing research include understanding patient risk profiles and developing risk mitigation strategies.