Postoperative Pelvic Abscess Risk in Gynecologic Surgery: A Four-Year Single Institution Experience

Background Hemostatic agents (HAs) are often used in gynecologic surgery to control bleeding when conventional methods such as sutures, clips, and electrocautery are insufficient. Tisseel Fibrin Sealant (FS) and oxidized regenerated cellulose (ORC) (e.g., Surgicel Powder) are two HAs that are commonly utilized; however, there is limited clinical data regarding their safety profiles, specifically regarding the risk of postoperative complications such as pelvic abscess. This study was initiated following observations of increased readmissions for pelvic abscesses in patients receiving ORC. Objective The primary objective of this retrospective study was to evaluate the association between the intraoperative use of FS versus ORC and the incidence of postoperative pelvic abscess and other associated complications in patients undergoing gynecologic surgery. Methods A retrospective chart review was conducted on women who underwent gynecologic surgery by the author at a single academic institution in Baltimore, Maryland, between 2019 and 2023. Patient and surgical characteristics were extracted, and comparisons were made between those who received FS versus ORC. The association between intraoperative HA use and postoperative pelvic abscess formation was examined. Secondary outcomes included the assessment of other major postoperative complications. Results A total of 607 patients were identified, with 422 receiving ORC and 185 receiving FS; 72 (11.9%) patients experienced postoperative complications. Pelvic abscess occurred in 10.4% (95% CI, 7.5%-13.3%) of ORC-treated patients compared with 0% (95% CI, 0%-1.6%) of FS-treated patients (p < 0.05). The overall complication rate was significantly greater at 15.6% (95% CI, 12.2-19.0%) for ORC versus 3.2% (95% CI 0.7%-5.8%) for FS. Readmission within 30 days of surgery occurred in 12.1% (95% CI, 9.0%-15.2%) of ORC-treated patients compared with 0.5% (95% CI, 0%-1.6%) of FS-treated patients, a significantly higher rate among those receiving ORC. Conclusion The use of ORC for adjunctive hemostasis in gynecologic surgery between 2019 and 2023 was associated with a significantly higher risk of pelvic abscess and other postoperative complications compared to FS. These findings suggest that FS may be a safer alternative for managing bleeding in gynecologic procedures, particularly in patients at higher risk for postoperative infections. Enhanced regimens of antibiotic prophylaxis are clinically significant and should be considered when ORC is used. These findings warrant prospective studies to validate these results and optimize clinical practice.