Risk factors for infection after hysterectomy for benign disease

Our objective was to identify risk factors for infections following hysterectomy for benign disease.

This population-based cohort study included hysterectomies recorded in the Swedish National Quality Register for Gynecological Surgery (GynOP) between 2005 and 2022. Data were linked with the Swedish Prescribed Drug Register, the National Patient Register, and Statistics Sweden. Postoperative infection was defined as a dispensed systemic antibiotic prescription within 21 days postoperatively (i.e., not local antibiotics or injectables). Crude and adjusted risk ratios (aRRs) were estimated using modified Poisson regression, adjusting for preoperative medications, demographic and perioperative factors.

Among 50 601 hysterectomies, 7153 women (14.1%) had a dispensed prescription of antibiotics postoperatively. Younger age, antidepressant or psycholeptic use, and previous abdominal or cesarean surgery were associated with increased risk of dispensed antibiotics. Endometriosis (aRR 1.30, 95% CI 1.06-1.58), preoperative use of immunoregulatory drugs (aRR 1.48, 95% CI 1.09-2.00), and Body Mass Index (BMI) ≥40 kg/m² (aRR 1.42, 95% CI 1.20-1.68) were independent risk factors. Perioperative complication was the strongest predictor (aRR 2.19, 95% CI 1.97-2.44) for dispensed antibiotics.

Prescribed and dispensed antibiotics after benign hysterectomy are common and influenced by several patient- and surgical factors. Identification of high-risk patients such as women with high BMI or using immunomodulating drugs, patients with endometriosis or previous abdominal surgery may support individualized preventive strategies and improve postoperative outcomes.