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Prophylactic antibiotics in abdominal hysterectomy
1Department of Obstetrics and Gynecology, Hadassah Ein-Kerem Medical Center, Jerusalem, Israel.
Journal of the American College of Surgeons
|November 1, 1994
Summary
Cephalosporins effectively prevent infections after abdominal hysterectomy. A single preoperative dose of first or second-generation cephalosporins offers the best cost-effective results for preventing post-hysterectomy complications.
Area of Science:
- Gynecologic surgery
- Infectious disease prevention
Background:
- Cephalosporins are widely used for chemoprophylaxis in gynecologic surgery.
- Their efficacy in total abdominal hysterectomy remains debated.
- This study assesses cephalosporins for preventing complications after elective abdominal hysterectomy.
Purpose of the Study:
- To evaluate the effectiveness of cephalosporins in preventing post-abdominal hysterectomy inflammatory complications.
- To determine the optimal cephalosporin strategy for chemoprophylaxis in this procedure.
Main Methods:
- A comprehensive literature review (1977-1991) using MEDLINE and manual searches.
- Inclusion of 17 prospective trials on cephalosporin prophylaxis.
- Meta-analysis of 2,752 patients to compare infection and febrile morbidity rates.
Main Results:
- Cephalosporins significantly reduced postoperative infection rates (p < 0.001).
- First-generation cephalosporins effectively prevented febrile morbidity, unlike some later generations.
- Multivariate analysis indicated no benefit of newer, more expensive cephalosporins; dose and administration route were significant factors.
Conclusions:
- Cephalosporin chemoprophylaxis is effective in preventing post-hysterectomy infectious complications.
- A single, preoperative intravenous dose of first-generation (cefazolin) or second-generation (cefoxitin) cephalosporin provides optimal cost-effective outcomes.