882 - Evaluating the Risk Factors in Postoperative Infections Following Hysterectomy Procedures: Is Antibiotic Prophylaxis the Issue?

Background: Infectious complications after hysterectomy procedures are associated with an additional financial burden and length of stay for patients. In addition, post-hysterectomy surgical site infection is a metric tied to hospital ranking and financial penalties. The objective of this study was to evaluate the appropriateness of surgical prophylaxis for hysterectomies in patients with postoperative infections.

Methods: This is a 1:1 case-control study, matched based on the year of surgery and surgeon performing the procedure, of women ≥ 18 years who underwent hysterectomies between 2013 and 2019. Cases were diagnosed with infection(s) attributable to the procedure within 90 days post-hysterectomy. Patients who did not receive prophylaxis were excluded. The primary outcome of this study was to determine if postoperative infections following hysterectomies were due to inappropriate antibiotic prophylaxis. Secondary outcomes included hospital readmission and mortality. The primary statistical tests utilized included descriptive statistics and chi-square test.

Results: The study included 86 patients, 43 in each group. Thirty percent of cases and 7% of controls received inappropriate prophylaxis. For cases, reason for inappropriateness was due to underdosing of cefazolin (38%) and gentamicin (54%), and overdosing of cefotetan (8%). For controls, cefazolin (33%) and gentamicin (67%) were underdosed. Twenty-three percent of the cases and 14% of the controls received inappropriate intraoperative redosing. The most common reason for inappropriateness was timing (40% of cases vs 50% of controls) followed by missed intraoperative redosing (50% of cases vs 33% of controls). No difference was observed in the proportion of cases and proportion of controls who received inappropriate treatment (p=0.21). Eighty-eight percent of cases and 5% of controls were readmitted within 3 months (p< 0.0001). Mortality was not noted in either group.

Conclusion: In this study, there was no statistically significant association between inappropriate antibiotic prophylaxis and infection. There was still a high incidence of inappropriate antibiotic prophylaxis in the cases. Therefore, education of providers on antibiotic dosing and criteria for intraoperative redosing is warranted.