A comparison of vulvar surgery outcomes after prophylactic antibiotic use

The primary objective of this study was to assess infection rate in patients undergoing vulvar surgery who received prophylactic antibiotics at time of surgery compared to patients who did not. Additionally, this study sought to determine the frequency of postoperative complications, predictors of complications, and determine whether antibiotics impacted the outcomes.

A prospective cohort study was conducted at a single clinical site encompassing the practice of 12 physicians who conduct vulvar surgeries. This study evaluated all women undergoing inpatient or outpatient vulvar surgery from this practice aged 18 years or older. Data obtained included demographics, pathologic diagnosis, antibiotic administration, characteristics of procedure and lesion, and postoperative infection rates and antibiotic prescriptions. Data was captured using electronic medical records.

Our final analysis included 172 patients. Of these, 59.3% (n = 102) of patients received prophylactic antibiotics. The most common procedure was wide local excision (58.5%, n = 97). The most common pathology of patients receiving antibiotics was high-grade dysplasia (46.1%, n = 47). There were 13 cases of infection (7.6%) diagnosed at the first postoperative visit. The majority of these patients (84.6%, n = 11) received prophylactic antibiotics. There was no relation between prophylactic antibiotic use and infection postoperatively (odds ratio 4, p = 0.08).

Postoperative infection and other complications were not significantly altered by the use of prophylactic antibiotics. A randomized controlled trial comparing prophylactic antibiotic use to no antibiotic use at time of vulvar surgery is a warranted next step.