The effect of prophylactic antibiotic administration for endometriosis surgery

Endometriosis is a chronic disease that impacts an estimated 10% of women. It is characterized by endometrial glands and stroma growing outside the uterus. Surgery is a mainstay of diagnosis and treatment. Infection is a leading complication following minimally invasive surgery (MIS) endometriosis excision. Currently, there are limited data on antibiotic prophylaxis for these cases.

To study the utility of prophylactic antibiotic administration in postoperative infection prevention among women undergoing MIS for endometriosis.

This retrospective cohort study included patients who had MIS for endometriosis at a quaternary academic medical center between January 2016 and May 2023. Patients who received antibiotic prophylaxis were compared to those who did not. The primary outcome was the rate of postoperative infections in each group. Secondary outcomes included rates of unscheduled postoperative visits, readmissions, and reoperations.

Of the 729 patients included, 595 (81.6%) patients received antibiotics, and 134 (18.4%) did not. Among women who received antibiotics, endometrioma excision (36.5% versus 23.1%, p = 0.003), ureterolysis (38.0% versus 25.4%, p = 0.007), and concomitant myomectomy (43.5% versus 11.9%, p < 0.001) were more common. The proportion of stage IV endometriosis was higher among women who received antibiotics (22.7% versus 11.9%, p = 0.005). Estimated blood loss, surgery length, and hospital admission times were lower in the no-antibiotics group. There were no infections in the no-antibiotics group and 7 (1.2%) in the antibiotics group.

Infectious complications were rare among patients undergoing MIS for endometriosis. The higher prevalence of infection among patients who received antibiotics likely reflects more severe endometriosis and higher surgical complexity in these cases. No infections in the no-antibiotics group suggest that prophylaxis may be safely omitted in simpler cases. A larger, prospective study is needed to investigate further the potential benefit of antibiotic prophylaxis in more complex endometriosis surgeries.