Risk factors of vaginal cuff infection in women undergoing laparoscopic hysterectomy for benign gynecological diseases

Abstract

Aim This study aimed to identify the risk factors for vaginal cuff infection after laparoscopic hysterectomy for benign gynecological diseases. Methods We conducted a retrospective cohort study among 1559 Japanese women who underwent total laparoscopic hysterectomy (TLH) for benign indications between 2014 and 2018 at Teine Keijinkai Hospital in Sapporo, Japan. All patients received preoperative antibiotics based on appropriate timing, choice, and weight‐based dosing. We assessed the risk factors of vaginal cuff infection after TLH, including demographic and clinical variables, and patient‐ and surgery‐related factors, using univariable and multivariable logistic regression analyses. Results Among all the patients who underwent TLH, 71 cases of vaginal cuff infections (4.6%) were recorded. Univariate analyses showed that current smoking, pathological result of adenomyosis, use of Seprafilm as an antiadhesive material, white blood cell counts on postoperative day (POD) 2, C‐reactive protein (CRP) level on POD2 and postoperative vaginal cuff hematoma were significantly associated with an increased risk of vaginal cuff infection. In multivariate analysis, current smoking, use of seprafilm, CRP level on POD2 and vaginal cuff hematoma were significantly associated with an increased risk of vaginal cuff infection. Conclusion Current smoking, use of seprafilm, CRP level on POD2 and vaginal cuff hematoma were identified as significant risk factors of vaginal cuff infection in the 30 days after surgery in Japanese women who underwent TLH for benign indications.

Predictive risk factors of vaginal cuff infection and vaginal cuff dehiscence in Egyptian female patients undergoing total laparoscopic hysterectomy for benign gynecological conditions

“…In our study we showed that rate of VCI after TLH was about 7% and VCD was 4% which is slightly higher than previous findings. Tsuzuki et al, [8] showed that the rate of 30-day VCI was 4.6%, which is higher than that reported in previous studies.…”

“…As we did not assess the association between seprafilm and VCI as it is not used in Egypt and due to few included patients in whom seprafilm was used in study of Tsuzuki et al, [8]. Further studies are needed to confirm associations between Seprafilm use and the occurrence of VCI after TLH.…”

“…Regarding intraoperative predictive factors of VCI Tsuzuki et al, [8] detected an association between seprafilm use and occurrence of postoperative VCI.…”

“…Previous reports showed that smoking was the main predictive risk factor for VCI [8], as it leads to ischemia and delayed healing of the vaginal wound healing that lead to higher rate of any surgical site infection (SSI) [10]. Tsuzuki et al, [8] showed that patients must stop smoking at least 30 days before any elective surgery. As the rate of smoking in our cohort was very low so we cannot consider it as a risk factor for development of VCI.…”

“…Identification of possible risk factors of VCI and VCD after TLH could help in reducing such annoying complications of patients and health care system [8].…”