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Author Spotlight: Advancing Pelvic Prolapse Treatment with a Non-Mesh Approach using Laparoscopic Pectopexy
Published on: October 25, 2024
Perioperative Antibiotic Choice and Postoperative Infectious Complications in Pelvic Organ Prolapse Surgery
Margot Le Neveu1, Erica Qiao2, Stephen Rhodes3
1Urology 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.
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.
Insights
Perioperative antibiotics with anaerobic coverage did not reduce infectious complications after pelvic organ prolapse surgery. Cefazolin alone was associated with fewer complications compared to alternative regimens in this national study.
Area of Science:
- Urology
- Gynecologic Surgery
- Infectious Disease
Background:
- Pelvic organ prolapse (POP) surgery is common, with infectious complications a significant concern.
- Perioperative antibiotic selection aims to minimize these risks, but optimal choices remain debated.
Purpose of the Study:
- To evaluate the association between perioperative antibiotic administration and postoperative infectious complications following POP surgery.
- Specifically, to determine if anaerobic coverage in antibiotic regimens reduces infectious complication rates.
Main Methods:
- Retrospective cohort study utilizing the Premier Healthcare U.S. national database (2000-2020).
- Included adult patients undergoing various POP surgical approaches (vaginal, laparoscopic, abdominal) with or without mesh and hysterectomy.
- Compared infectious complication rates based on guideline-concordant antibiotic regimens, focusing on anaerobic coverage.
Main Results:
- Over 130,000 POP surgeries were analyzed. Cefazolin was the most common single agent.
- Regimens including clindamycin + aminoglycoside were linked to higher surgical site infections (OR=1.37) and infectious morbidity (OR=1.26) versus cefazolin.
- Adding metronidazole to cefazolin showed no significant reduction in surgical site infections (OR=1.09).
Conclusions:
- Alternative perioperative antibiotics, including those with anaerobic coverage, were not associated with reduced infectious complications post-POP surgery.
- Cefazolin alone appears to be a safe and effective choice in this large national sample.
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