Topical Hemostatic Agents and the Risk of Pelvic Infection in Gynecologic Surgery

As hemostatic agent use becomes routine, adverse effects must be assessed, including infection. This study compared pelvic infection after the use of different hemostatic agents.

Pelvic infection within 6 weeks of surgery was assessed in a retrospective cohort study, with a subanalysis for hysterectomies. Fisher's exact test was used to compare cases.

This study was conducted at a large midwestern hospital.

Patients who underwent benign gynecologic surgeries where a hemostatic agent was used from 2009 to 2019, excluding those who were younger than 18 years, were pregnant, had coagulopathies, had malignancies, or had plasma allergies.

This study evaluates benign gynecologic surgeries with hemostatic agent use.

Among 3206 surgeries, biologic agents were used most frequently (54.7%), followed by mechanical (41.7%) and combined agents (3.6%). Biologic agents had the lowest infection rate (0.3%) compared with mechanical (1.0%) and combined agents (1.8%; p = .023). Absorbable gelatin sponge use was associated with the highest infection rate overall (7.8% vs 0.5%; p <.001) and in hysterectomy cases (4.3% vs 0.3%; p = .003). Thrombin-fibrinogen agents were associated with lower infection rates overall (0.4% vs 1.1%; p = .018), although this was not significant in the hysterectomy subanalysis (p = .22). After adjusting for patient and surgical factors, laparoscopic, robotic, and hysterectomy procedures were associated with lower infection odds than open and nonhysterectomy approaches. Operative time was independently associated with infection.

Careful use of hemostatic agents may lower infection risk. Risk appears higher with mechanical and combined agents than with biologic agents. The absorbable gelatin sponge may carry a higher risk of infection.