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VOLUME 5 , ISSUE 1 ( January-June, 2017 ) > List of Articles


Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country

Erum S Khan, Sheikh Irfan, Natasha Khalid

Citation Information : Khan ES, Irfan S, Khalid N. Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country. J South Asian Feder Menopause Soc 2017; 5 (1):23-27.

DOI: 10.5005/jp-journals-10032-1100

Published Online: 01-07-2016

Copyright Statement:  Copyright © 2017; The Author(s).



Surgical site infections (SSIs) are among the most common complications in surgical patients and have serious consequences for outcomes and costs. There is a dearth of information on risk factors for developing SSI in patients undergoing gynecologic cancer surgery, and this has not been studied using national data.


The objectives of this study were to estimate the prevalence, preoperative and operative risk factors associated with the higher risk of SSIs in gynecologic cancer patients undergoing surgery in a tertiary care facility in a developing country.


Department of Obstetrics and Gynaecology, Aga Khan University Hospitals, Karachi, Sindh, Pakistan.

Materials and methods

Retrospective record review of gynecologic oncology patients admitted for surgery from January 2015 to December 2015 was performed.


A total of 100 patients met the inclusion criteria. Of these, 15 were identified with SSIs, which were all found to be of the superficial type. Approximately, 44, 40, and 7% were diagnosed with endometrial, ovarian, and cervical cancers respectively. The mean time from surgery to developing SSI was 12.9 days. Among endometrial cancer, 22.7% (10/44) had SSI compared with 7.5% (3/40) for ovarian cancer and 14.2% (1/7) for cervical cancer. The significant predictors of SSI were body mass index ≥35 (p-value <0.004), endometrial cancer diagnosis, the American Society of Anesthesiologists class more than 3, modified surgical complexity scoring system 3 to 4, and blood sugar levels more than 180 mg/dL within 48 hours after surgery in known diabetics.


About 15% of patients undergoing laparotomy for gynecologic malignancy developed SSIs. In this study, we identified several risk factors for developing SSI among gynecologic cancer patients. These findings may contribute toward identification of patients at risk for SSIs, and the development of strategies to reduce SSI rate and potentially reduce the cost of care in gynecologic cancer surgery.

How to cite this article

Khan ES, Irfan S, Khalid N. Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country. J South Asian Feder Menopause Soc 2017;5(1):23-27.

  1. Health Protection Scotland; 2012 [cited 2012 Jun 27]. Available from:
  2. Surgical site infections: how high are the costs? J Hosp Infect 2009 Jul;72(3):193-201.
  3. Adverse impact of surgical site infections in English hospitals. J Hosp Infect 2005 Jun;60(2):93-103.
  4. Decreased surgical site infection (SSI) rates for hip and knee arthroplasty following multiple infection control interventions. Am J Infect Control 2005 Jun;33(5):e168-e169.
  5. National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1990–May 1999, issued June 1999. A report from the NNIS System. Am J Infect Control 1999 Dec;27(6):520-532.
  6. Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000. J Hosp Infect 2003 Jun;54(2):141-148.
  7. Five years working with the German nosocomial infection surveillance system (Krankenhaus Infektions Surveillance System). Am J Infect Control 2003 Aug;31(5):316-321.
  8. Repeated prevalence investigations on nosocomial infections for continuous surveillance. J Hosp Infect 2000 May;45(1):47-53.
  9. The French Prevalence Survey Study Group. J Hosp Infect 2000 Nov;46(3):186-193.
  10. Surgical site infections: reanalysis of risk factors. J Surg Res 2002 Mar;103(1):89-95.
  11. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992 Oct;20(5):271-274.
  12. Comparison of robotic and other minimally invasive routes of hysterectomy for benign indications. Am J Obstet Gynecol 2016 Nov;215(5):650.e1-650.e8.
  13. Feasibility and safety of video endoscopic inguinal lymphadenectomy in vulvar cancer: a systematic review. PLoS One 2015 Oct;10(10):e0140873.
  14. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: gynecologic Oncology Group LAP2 Study. J Clin Oncol 2012 Mar;30(7):695-700.
  15. Colorectal surgery surgical site infection reduction program: a national surgical quality improvement program-driven multidisciplinary single institution experience. J Am Coll Surg 2013 Jan;216(1):23-33.
  16. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009 Jun;37(5):387-397.
  17. Surgical site infection after primary surgery for epithelial ovarian cancer: predictors and impact on survival. Gynecol Oncol 2015 Feb;136(2):278-284.
  18. Using bundled interventions to reduce surgical site infection after major gynecologic cancer surgery. Obstet Gynecol 2016 Jun;127(6):1135-1144.
  19. Predictive factors for surgical site infection in general surgery. Surgery 2008 Oct;144(4):496-501;discussion 501-503.
  20. Prospective study of wound complications in continuous infrainguinal incisions after lower limb arterial reconstruction: incidence, risk factors, and cost. Surgery 1996 Apr;119(4):378-383.
  21. Wound infection after infrainguinal bypass operations: multivariate analysis of putative risk factors. Surg Infect (Larchmt) 2000 Winter;1(4):257-263.
  22. Body mass index: surgical site infections and mortality after lower extremity bypass from the National Surgical Quality Improvement Program 2005-2007. Ann Vasc Surg 2010 Jan;24(1):48-56.
  23. Wound infection after abdominal hysterectomy: effect of the depth of subcutaneous tissue. Am J Obstet Gynecol 1995 Aug;173(2):465-469; discussion 469-471.
  24. Predictors of surgical site infection after open lower extremity revascularization. J Vasc Surg 2011 Aug;54(2):433-439.
  25. Diabetes mellitus and cardiothoracic surgical site infections. Am J Infect Control 2005 Aug;33(6):353-359.
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