Perioperative Antibiotic Choice and Postoperative Infectious Complications in Pelvic Organ Prolapse Surgery

Margot Le Neveu; Erica Qiao; Stephen Rhodes; Anne Sammarco; Adonis Hijaz; David Sheyn

doi:10.1016/j.jmig.2024.10.004

Perioperative Antibiotic Choice and Postoperative Infectious Complications in Pelvic Organ Prolapse Surgery

J Minim Invasive Gynecol. 2024 Oct 16:S1553-4650(24)01446-8. doi: 10.1016/j.jmig.2024.10.004. Online ahead of print.

Authors

Margot Le Neveu¹, Erica Qiao², Stephen Rhodes³, Anne Sammarco⁴, Adonis Hijaz³, David Sheyn³

Affiliations

¹ Urology Institute, University Hospitals/Cleveland Medical Center (Le Neveu, Rhodes, Hijaz, and Sheyn), Cleveland, Ohio; Division of Female Pelvic Medicine and Reconstruction, University Hospitals/Cleveland Medical Center (Le Neveu and Sammarco), Cleveland, Ohio. Electronic address: Margot.LeNeveu@uhhospitals.org.
² Oregon Health and Science University (Qiao), Portland, Oregon.
³ Urology Institute, University Hospitals/Cleveland Medical Center (Le Neveu, Rhodes, Hijaz, and Sheyn), Cleveland, Ohio.
⁴ Division of Female Pelvic Medicine and Reconstruction, University Hospitals/Cleveland Medical Center (Le Neveu and Sammarco), Cleveland, Ohio.

PMID: 39419278
DOI: 10.1016/j.jmig.2024.10.004

Abstract

Objective: The objective of this study was to determine how rates of postoperative infectious complications after pelvic organ prolapse surgery differ based on perioperative antibiotic administered. In particular, we sought to determine whether anaerobic coverage is associated with reduced rates of infectious complications.

Design: This was a retrospective cohort study.

Setting: Premier Healthcare U.S. national database, a comprehensive all-payer dataset capturing patients from urban and rural nonprofit, community, and teaching hospitals.

Participants: Adult patients who underwent vaginal, laparoscopic, and/or abdominal prolapse surgery with or without hysterectomy from January 2000 to March 2020. Procedures with and without mesh were included.

Interventions: Rates of infectious complications were compared among patients who received guideline-concordant antibiotic regimens, including those with anaerobic coverage. The primary outcome was any surgical site infection within 30 days of surgery without mesh or 90 days of surgery involving mesh.

Results: Among 130,198 prolapse surgeries, the most common antibiotic regimens were cefazolin (n = 97,058, 74.5%), second-generation cephalosporin (n = 16,442, 12.6%), clindamycin + aminoglycoside (n = 8,397, 6.4%) and cefazolin + metronidazole (n = 4,328, 3.3%). On multivariable logistic regression, only clindamycin + aminoglycoside was associated with a higher rate of surgical site infections (OR = 1.37; 95% CI 1.09-1.72) and other infectious morbidity (OR = 1.26; 95% CI 1.12-1.42) when compared to cefazolin alone. The addition of metronidazole to cefazolin was not associated with reduced rates of surgical site infections (OR = 1.09; 95% CI 0.82-1.45). Obesity (OR = 1.22; 95% CI 1.03-1.43), diabetes without complication (OR = 1.30; 95% CI 1.08-1.57), Charlson comorbidity score >0 (OR = 1.24; 95% CI 1.06-1.45), and tobacco use (OR = 1.22, 95% CI 1.05-1.40) were also associated with increased composite surgical site infection.

Conclusion: Compared with cefazolin alone, the use of alternative perioperative antibiotics, including those with anaerobic coverage, was not associated with reduced infectious complications after pelvic organ prolapse surgery in this U.S. national sample.

Keywords: Antibiotic prophylaxis; Cefazolin; Postoperative infections; Surgical complications; Urogynecology and reconstructive pelvic surgery.