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

a cohort study

El-Nashar, Sherif A. MBBCh, MS
Diehl, Courtenay L. MD
Swanson, Casey L. PA-C
Thompson, Rodney L. MD
Cliby, William A. MD
Famuyide, Abimbola O. MD
Stanhope, Robert C. MD

^aDepartment of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
^bDivision of Infectious Disease, Mayo Clinic, Rochester, MN

Reprints: C. Robert Stanhope, MD, Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905. [email protected].

Cite this article as: El-Nashar SA, Diehl CL, Swanson CL, et al. Extended antibiotic prophylaxis for prevention of surgical-site infections in morbidly obese women who undergo combined hysterectomy and medically indicated panniculectomy: a cohort study. Am J Obstet Gynecol 2010;202:306.e1-9.

Authorship and contribution to the article is limited to the 7 authors indicated. There was no outside funding or technical assistance with the production of this article.

Presented at the 76th Annual Meeting of the Central Association of Obstetricians and Gynecologists, Maui, HI, Oct. 25-28, 2009.

Received Jun. 16, 2009; revised Dec. 19, 2009; accepted Jan. 20, 2010

American Journal of Obstetrics and Gynecology 202(3):p 306e1-306e9, March 2010.

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/m²) 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 ± 12.1 years, and mean body mass index was 42.6 ± 8.4 kg/m² (range, 30-86.4 kg/m²). 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.