Title: Risk Factors for Surgical Site Infections Following Microwave Ablation of the Uterus:
A Retrospective Cohort Study
Version: 1 Date: 12 Sep 2024
Reviewer:  Suppadech Tunruttanakul
Reviewer's report:
Review of Manuscript: "Risk Factors of Surgical Site Infections After Microwave Ablation of
the Uterus"
Thank you for the opportunity to review this manuscript. The study addresses an important topic;
however, there are several areas that need improvement to enhance clarity, completeness, and
scientific rigor. My specific comments are outlined below:
1. Materials and Methods:
-The Methods section lacks sufficient detail on how the study was conducted. In the text, only
patient comorbidities are mentioned, while Table 1 and Table 5 include additional parameters
such as ASA status, diabetes, etc. Additionally, it is unclear why ASA was classified as I vs. II,
as both are usually comparable. Why not classify it as ASA III vs. I and II? The Methods section
should comprehensively describe all factors assessed in the study to ensure reproducibility.
-Smoking, a known risk factor for SSIs, should be included as an assessed variable in the study.
-Figure 1 presents the types of antibiotics used, which is informative. However, the Methods
section does not mention regarding antibiotic data were collected. This should be clearly stated.
-Additionally, Figure 1 does not clearly explain the purpose of the antibiotics (e.g., prophylaxis
or treatment) or why two circles representing antibiotics are shown. Figures and tables should
be able to stand alone, so their content must be more thoroughly explained.
-The choice of factors in the study needs to be explained (why choosing these factors) with
appropriate references.
2. Statistical Analysis: When predictive models, such as logistic regression, are employed, post-
estimation analyses, such as goodness-of-fit tests, should be included. These tests help readers
understand how well the model explains or predicts the outcome (SSIs).
3. Tables:
-Many of the tables need revision, particularly those involving binary variables. For example, if
a variable is listed as "male," readers will naturally infer that the other category is "female," so
it's unnecessary to present both proportions. This also applies to showing reference categories
in tables—this practice can be redundant and take up valuable space.
-Related tables using the same analyses should be merged to reduce the manuscript's length and
improve clarity for readers.
-In most of the tables, it is unclear what the numbers in parentheses represent—are they
proportions? This should be clarified. Moreover, medians should not have ranges; they should
be reported as a single number. What are the range after median?
4. Results:
-In the Results section, whenever outcomes are presented, a reference to the corresponding table
should be made. The sentence "More details are shown in Table 2, Table 3, Table 4, and Fig. 1"
is vague. Readers may struggle to understand where specific numbers are coming from.
5. Additional Issues:
-Why was 180 minutes chosen as the cut-off for operative time? The rationale behind this cut-
off value should be explained.
-There is no mention of a sample size calculation, which is important for determining the study’s
statistical power.
-The study design (e.g., cohort, case-control) is not clearly stated and should be included in the
Methods.
-It is unclear which factors were included in the multivariable analysis. These should be
explicitly stated.
-For example, the sentence 'But there is a huge gap in surgical duration between the groups
(160 [121.25–201], 90 [74,112], P < 0.001).' The numbers in parentheses should be clearly
defined (e.g., are they interquartile ranges?). Additionally, the formatting (e.g., number–number
vs. number, number) should be consistent. This should be checked throughout the manuscript.