Surgical Site Infection After Sacral Neuromodulation: Impact of Postoperative Antibiotics

There are limited data to guide practices to reduce surgical site infections following sacral neuromodulation; however, many surgeons prescribe prophylactic postoperative antibiotics after device implantation.

The aim of the study was to compare the proportion of patients with sacral neuromodulation device-associated surgical site infections after use of prophylactic postoperative antibiotics versus none.

This was a multicenter retrospective cohort study of patients undergoing sacral neuromodulation device implantation at 11 institutions from January 2014 to December 2023, comparing outcomes in patients who did versus did not receive prophylactic postoperative antibiotic treatment. The primary outcome was surgical site infection within 90 days. The proportions of surgical site infections were compared, and regression analyses were performed to identify variables associated with surgical site infection.

A total of 1,798 patients met inclusion criteria. Within this population, 67 surgical site infections (3.7%) were identified. Patients who received postoperative antibiotics (898/1798, 49.9%) were older (63.2 years vs 61.0 years, P < 0.001), and a greater proportion had staged procedures (57.9% vs 49.8%, P < 0.001). The proportion of surgical site infections and device explantations were not different between groups (3.6% vs 3.9%, P = 0.8) and (2.0% vs 2.8%, P = 0.2), respectively. After adjusting for age in a multivariate analysis, prophylactic postoperative antibiotic use was not associated with surgical site infections (0.98, 95% CI: 0.61-1.61, P = 0.94).

Rates of surgical site infection following device implantation are low. Our findings suggest that the use of prophylactic postoperative antibiotics has minimal effect on reducing infection after device implantation. Further research is needed to explore underlying factors influencing this relationship.