Wound infection after abdominal hysterectomy: Effect of the depth of subcutaneous tissue

OBJECTIVE: Our purpose was to determine the effect of the depth of the subcutaneous tissue at the operative site on abdominal wound infection after hysterectomy. STUDY DESIGN: A prospective study was performed of women undergoing abdominal hysterectomy and not receiving antibiotic prophylaxis who underwent maximum vertical measurement of their subcutaneous incisions before the abdominal cavity was surgically entered. Additional demographic and perioperative data previously associated with wound infection were collected and analyzed. Surgical technique was standardized among the three attending surgeons involved. RESULTS: Wound infection occurred in 17 of 150 (11.3%) women undergoing abdominal hysterectomy. Univariate analysis identified the following risk factors as being significantly associated with wound infection: depth of subcutaneous tissue (p = 0.0004), preoperative serum albumin (0.0015), weight (p = 0.0029), and body mass index (p = 0.0032). Logistic regression analysis confirmed the thickness of the subcutaneous tissue as the only significant risk factor for wound infection (p = 0.04) (odds ratio 1.37, 95% confidence interval 1.01 to 1.86). No patients with a maximum depth of subcutaneous tissue <3 cm had a wound infection. CONCLUSION: We conclude that the depth of subcutaneous tissue is the most significant risk factor associated with abdominal wound infection after hysterectomy.