Perioperative Antibiotic Use and Associated Infectious Outcomes at the Time of Myomectomy

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 133; no. 4; pp. 626 - 635
• Main Authors: Kim, Annie J, Clark, Nisse V, Jansen, L Joya, Ajao, Mobolaji O, Einarsson, Jon I, Gu, Xiangmei, Cohen, Sarah L
• Format: Journal Article
• Language: English
• Published: United States by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved 01.04.2019
• Subjects: Adult; Antibiotic Prophylaxis - statistics & numerical data; Cohort Studies; Female; Humans; Infections - epidemiology; Leiomyoma - surgery; Massachusetts; Middle Aged; Perioperative Care - methods; Postoperative Complications; Retrospective Studies; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control; Uterine Myomectomy - adverse effects; Uterine Myomectomy - methods; Uterine Neoplasms - surgery; Massachusetts
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0000000000003160

OBJECTIVE:To report the frequency of perioperative antibiotic use at time of myomectomy and associated risk of infectious outcomes. METHODS:We conducted a retrospective cohort study including all women who underwent any route of myomectomy from 2009 to 2016 at two academic hospitals in Boston, Massachusetts. Cases involving chromopertubation or conversion to hysterectomy were excluded from further analysis. Medical records were queried for the use or nonuse of perioperative antibiotics, as well as baseline patient factors and perioperative outcomes. Statistical analyses included univariate comparisons between treatment groups, as well as multivariable logistic regression analyses of infectious morbidity controlling for patient age, route of surgery, presence of high-risk factors, any intraoperative complication, myoma weight, and entrance into the endometrial cavity. Matched cohort analysis also was performed to confirm findings in the setting of underlying differences between groups. RESULTS:A total of 1,211 patients were included in the myomectomy cohort, 92.7% of whom received perioperative antibiotics at the time of surgery. Demographic characteristics were similar between the group that received and the group that did not receive antibiotics. The cases with antibiotic use were associated with longer operative times, higher estimated blood loss, and greater myoma burden. No difference was noted with regard to intraoperative or postoperative complications. Surgical site infection occurred more commonly in the group that did not receive antibiotics (2.9% vs 6.8% in the antibiotic and no-antibiotic groups, respectively; effect size 0.43, 95% CI 0.18–0.97 P=.04), representing a nearly fourfold increase in odds of any surgical site infection in the absence of perioperative antibiotic use (adjusted odds ratio 3.77, 95% CI 1.30–10.97, P=.015). CONCLUSION:A high frequency of antibiotic use was noted at time of myomectomy, despite lack of clear evidence supporting the practice. Patients who received perioperative antibiotics had fewer postoperative infectious outcomes and, in particular, experienced a lower incidence of surgical site infection.