Risk factors for surgical site infections after hysterectomy: A systematic review and meta-analysis

Abstract

Background & Objective: Surgical site infections (SSIs) are a common complication following hysterectomy that is associated with higher morbidity, prolonged hospitalization, and a healthcare burden. Identifying key risk factors for SSIs will allow the development of effective prevention measures. Our objective weas to review and analyze potential risk factors associated with SSIs after hysterectomy, focusing on modifiable and non-modifiable contributors.

Methodology: PubMed, EMBASE, Scopus, and CENTRAL databases were searched based on the PRISMA guidelines. The last electronic search was carried out on 30th January 2025 to include studies to date. Sixteen studies with 165,589 participants were included. Random-effects meta-analysis was done to calculate odds ratios (OR) and 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic. P < 0.05 was considered significant. The protocol was registered in PROSPERO (CRD42025629931).

Results: A total of 16 studies were included in this review. Key risk factors for SSIs included obesity [Body Mass Index (BMI) >30 kg/m²; OR = 3.34, 95% CI: 2.45–4.56], diabetes mellitus (OR = 1.82, 95% CI: 1.41–2.35), smoking (OR = 1.76, 95% CI: 1.37–2.26), and prolonged operative time (>2 hours; OR = 1.59, 95% CI: 1.19–2.11). Procedural factors such as open surgical approaches (OR = 2.88, 95% CI: 2.24–3.72) significantly increased SSIs risk. Additional contributing factors included prolonged hospital stays (>1 day; OR = 2.47, 95% CI: 1.78–3.43) and bowel resection (OR = 3.07, 95% CI: 1.71–5.49).

Conclusion: Obesity, diabetes, smoking, and prolonged operative time are risk factors for SSIs that may be considered as modifiable for intervention. Evaluating these risk factors in patients undergoing hysterectomy may significantly reduce the burden of SSIs, improve outcomes, and lower healthcare costs.

Registration No. (PROSPERO: # CRD42025629931).