Prophylactic use of antibiotics with abdominal hysterectomy: ACOG Committee Opinion: Committee on Gynecologic Practice Number 82-April 1990 ( Replaces #37, June 1985 )

Extended antibiotic prophylaxis for prevention of surgical-site infections in morbidly obese women who undergo combined hysterectomy and medically indicated panniculectomy: a cohort study

OBJECTIVE

The purpose of this study was to compare surgical-site infection rates in obese women who had extended prophylactic antibiotic (EPA) vs standard prophylactic antibiotic.

STUDY DESIGN

An electronic records-linkage system identified 145 obese women (body mass index, >30 kg/m(2)) who underwent combined hysterectomy and panniculectomy from January 1, 2005, through December 31, 2008. The EPA cohort received standard antibiotics (cefazolin, 2 g) and continued oral antibiotic (ciprofloxacin) until removal of drains. Regression models were used to adjust for known confounders.

RESULTS

The mean age was 56.0 + or - 12.1 years, and mean body mass index was 42.6 + or - 8.4 kg/m(2) (range, 30-86.4 kg/m(2)). The EPA cohort experienced fewer surgical-site infections (6 [5.9%] vs 12 [27.9%]; P < .001; adjusted odds ratio, 0.16; 95% confidence interval, 0.04-0.51; P < .001), had lower probability of incision and drainage (3 [2.9%] vs 5 [11.6%]; P = .05), and required fewer infection-related admissions (5 [4.9%] vs 6 [13.9%]; P = .08).

CONCLUSION

Extended antibiotic prophylaxis can reduce surgical-site infections in obese women after combined hysterectomy and panniculectomy.

Complications of hysterectomy

The complications of hysterectomy are discussed, generally speaking their definition is poorly standardized and direct comparisons are extremely difficult. Furthermore, there is uncertainty as to what is meant by laparoscopic hysterectomy. The complications are discussed as post-operative fever, haemorrhage, injury to adjacent organs, other complications and life-threatening events. The incidence of post-operative infection and haemorrhage is least with the laparoscopic approach, but injury to surrounding organs is probably greater. In 1982, the Collaborative Review of Sterilization study data suggested an average woman of reproductive age with no pre-existing medical condition, no previous abdominal surgery, and who received prophylactic antibiotics, was best served by vaginal hysterectomy without colpororrhaphy rather than an abdominal procedure. This does not seem to have changed. The incidence of abdominal hysterectomy may be reduced by adding laparoscopy to vaginal hysterectomy to deal with adhesive disease, endometriosis or adnexal disease. Laparoscopic hysterectomy is feasible and safe but the indications for this approach have not yet been established.