Prophylactic Antibiotic Choice and Risk of Surgical Site Infection After Hysterectomy

Abstract

OBJECTIVE To evaluate associations between prophylactic preoperative antibiotic choice and surgical site infection rates after hysterectomy. METHODS A retrospective cohort study was performed of patients in the Michigan Surgical Quality Collaborative undergoing hysterectomy from July 2012 to February 2015. The primary outcome was a composite outcome of any surgical site infection (superficial surgical site infections or combined deep–organ space surgical site infections). Preoperative antibiotics were categorized based on the recommendations set forth by the American College of Obstetricians and Gynecologists and the Surgical Care Improvement Project. Patients receiving a recommended antibiotic regimen were categorized into those receiving beta-lactam antibiotics and those receiving alternatives to beta-lactam antibiotics. Patients receiving non-recommended antibiotics were categorized into those receiving overtreatment (excluded from further analysis) and those receiving non-standard antibiotics. Multivariable logistic regression models were developed to estimate the independent effect of antibiotic choice. Propensity score matching analysis was performed to validate the results. RESULTS The study included 21,358 hysterectomies. The overall rate of any surgical site infection’ was 2.06% (N=441). Unadjusted rates of ‘any surgical site infection’ were 1.8%, 3.1% and 3.7% for beta-lactam, beta-lactam alternatives and non-standard groups, respectively. After adjusting for patient and operative factors within clusters of hospitals, compared to the beta-lactam antibiotics (reference group), the risk of ‘any surgical site infection’ was higher for the group receiving beta-lactam alternatives (OR 1.7, CI 1.27–2.07) or the non-standard antibiotics (OR 2.0, CI 1.31–3.1). CONCLUSION Compared to women receiving beta lactam antibiotic regimens, there is a higher risk of surgical site infection after hysterectomy among those receiving a recommended beta lactam alternative or non-standard regimen.

Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

“…Colorectal surgery, consistently associated with the highest SSI rates, has been particularly notable for equivocal results on SSI reduction bundling in various studies using a mixture of interventions [7, 9, 13–21]. In the field of gynecology, such studies are lacking, despite SSI rates of 2–4% in patients undergoing hysterectomy and an approximate 30% rate of hospital readmissions attributable to postoperative SSIs [4, 22, 23]. …”

Are perioperative bundles associated with reduced postoperative morbidity in women undergoing benign hysterectomy? Retrospective cohort analysis of 16,286 cases in Michigan

“…2 In gynecology, recent bundle studies including pre-, intra-, and postoperative processes, including attention to appropriate antibiotic use, have shown a reduced risk of surgical site infection (SSI) after implementation. 4, 6 …”

“…2, 3 In gynecologic surgery, use of evidence-based guidelines, such as appropriate preoperative antibiotic prophylaxis, has been shown to decrease the risk of infectious complications. 4 …”

Are Perioperative Bundles Associated With Reduced Postoperative Morbidity in Women Undergoing Benign Hysterectomy? Retrospective Cohort Analysis of 16,286 Cases in Michigan

“…2 In gynecology, recent bundle studies including pre-, intra-, and postoperative processes, including attention to appropriate antibiotic use, have shown a reduced risk of surgical site infection (SSI) after implementation. 4,6 Given the success of team-based interventions such as checklists and bundle processes in improved safety across many settings as mentioned above, it is worthwhile to explore expanding their use into gynecologic surgery. 6 Often the individual processes involved in a care bundle are small items whose benefit is well-established.…”

“…2,3 In gynecologic surgery, use of evidence-based guidelines, such as appropriate preoperative antibiotic prophylaxis, has been shown to decrease the risk of infectious complications. 4 Collective bundling of more than one relevant evidence-based process may help optimize outcomes and has been shown to decrease surgical site infection rate in gynecologic oncology and colorectal surgery. [5][6][7] However, evidence supporting the use of perioperative bundles for hysterectomy and what processes they might contain is lacking despite the fact that over 400,000 women per year undergo the procedure in the U.S. 8 Therefore, the aim of our study was to evaluate a perioperative bundle of evidence-based processes for benign hysterectomy and retrospectively evaluate its impact on postoperative outcomes using a statewide hysterectomy database.…”