Purpose of review Surgical site infection (SSI) remains one of the most common postoperative surgical complications. Prevention and appropriate treatment remain paramount. Recent findings Evidence-based recommendations include recognition and reduction of preoperative risks including hyperglycemia and smoking, treatment of preexisting infections, skin preparation with chlorhexidine gluconate, proper use of preoperative antibiotics, and implementation of prevention bundles. Consideration should be given to the use of dual antibiotic preoperative treatment with cephazolin and metronidazole for all hysterectomies. Summary Despite advancements, SSI in gynecologic surgery remains a major cause of perioperative morbidity and healthcare cost. Modifiable risk factors should be evaluated and patients optimized to the best extent possible prior to surgery. Preoperative risks include obesity, hyperglycemia, smoking, and untreated preexisting infections. Intraoperative risk-reducing strategies include appropriate perioperative antibiotics, correct topical preparation, maintaining normothermia, and minimizing blood loss. Additionally, early recognition and prompt treatment of SSI remain crucial.
Study Objective To determine the incidence of perioperative COVID-19 in women undergoing benign gynecologic surgery, and to evaluate perioperative complication rates in patients with active, prior or no prior SARS-CoV-2 infection. Design Multicenter prospective cohort study Setting Ten institutions in the United States Patients Patients over the age of 18 years who underwent benign gynecologic surgery from July 1, 2020 to December 31, 2020 were included. All patients were followed from the time of surgery until 10 weeks post-operatively. Those with intra-uterine pregnancy or known gynecologic malignancy were excluded. Interventions Benign gynecologic surgery Measurements The primary outcome was the incidence of perioperative COVID-19 infections which was stratified as 1) prior COVID-19 infection, 2) pre-operative COVID-19 infection and 3) post-operative COVID-19 infection. Secondary outcomes included adverse events and mortality following surgery, as well as predictors for post-operative COVID-19 infection. If surgery was delayed due to the COVID-19 pandemic, the reason for postponement and any subsequent adverse event was recorded. Main Results Of 3423 patients included for final analysis, 189 (5.5%) postponed their gynecologic surgery during the pandemic. Forty-three patients (1.3% of total cases) were due to a history of COVID-19. The majority (182 [96.3%]) had no sequelae attributed to surgical postponement. Following hospital discharge to 10 weeks post-operatively, 39 (1.1%) patients became infected with SARS-CoV-2. The mean duration of time between hospital discharge and the follow-up positive COVID-19 test was 22.1 ± 12.3 days (range 4-50 days). Eleven (31.4% of post-operative COVID-19 infections, 0.3% of total cases) of the newly diagnosed COVID-19 infections occurred within 14 days of hospital discharge. On multivariable logistic regression, living in the Southwest (adjOR 6.8) and single-unit increase in age-adjusted Charlson co-morbidity index (adjOR 1.2) increased the odds of post-operative COVID-19 infection. Peri-operative complications were not significantly higher in patients with a history of prior positive COVID-19 compared to those without a history of COVID-19, though the mean duration of time between prior COVID-19 diagnosis and surgery was 97 days (14 weeks). Conclusion In this large multi-center prospective cohort study of benign gynecologic surgeries, only 1.1% of patients developed a post-operative COVID-19 infection, with 0.3% of infection in the immediate 14-days after surgery. The incidence of post-operative complications was not different in those with and without prior COVID-19 infections.
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