Infectious Causes of 30-Day Unplanned Hospital Encounters and Readmissions After Hysterectomies: A Single Institutional Study

Objective: There is a paucity of studies identifying causes of unplanned hospital readmissions due to infectious etiology. The aim of this study was to investigate the causes of posthysterectomy infections 30 days after hospital discharge. Material and Methods: For this retrospective cohort study, the current authors queried 3510 consecutive adult patients (≥ 18 years old) undergoing hysterectomy at a major academic institution from 2010 to 2015. Of these patients, 453 (12.9%) 30-day hospital encounters or readmissions after hospital discharge were identified, and 193 (42.6%) of these cases were reviewed retrospectively. Demographics, comorbidities, intra- and postoperative complications, and 30-day complication and readmission rates after hospital discharge were collected for each patient. The primary outcomes were 30-day postdischarge infection rates and complications. Results: Of the 193 patients, 33 (17.1%) patients returned to the hospital within 30 days postdischarge, primarily due to infectious etiology. The mean age and body mass index (kg/m2) were 50.9 ± 13.3 years and 29.7 ± 9.2 kg/m2, respectively. The most prevalent comorbidities were hypertension (42.4%) and anemia (42.4%). The majority of hysterectomies were for benign etiologies (72.7%), with total abdominal hysterectomy (36.4%) and total laparoscopic hysterectomy (36.4%) as the most common surgical approaches. The mean operative time and estimated blood loss were 314.3 ± 193.5 minutes and 340.2 ± 457.4 mL, respectively. There were 6.1% unplanned intensive-care unit transfers, with urinary-tract infection (UTI; 15.2%) and fever (12.1%) as the most prevalent postoperative complications. The mean time from hospital discharge to return was 13.7 ± 9.9 days, with 66.7% of patients subsequently being readmitted. The most prevalent infections were superficial surgical-site infections (SSIs; 33.3%), intra-abdominal/pelvic abscesses (27.3%) and UTIs (24.2%). Conclusions: This study suggests that the primary infectious causes of 30-day unplanned hospital encounters are superficial SSIs, abscess formation, and UTIs, which result in high readmission rates.