Impact of Perioperative Safety Bundle for Prevention of Infection in Urogynecology Surgery

Objectives: Our primary aim was to compare the surgical site infection rate in urogynecologic vaginal surgeries with and without a safety bundle.

Methods: This was a single center retrospective cohort study of women who underwent urogynecologic vaginal surgery. Electronic health records from 2018 to 2021 were reviewed for patient demographics, comorbid conditions, social history, surgical data, and postoperative data. The rates of SSI between two separate sites within the same institution were compared. Site A site used a safety bundle for SSI prevention and Site B adhered to Surgical Care Improvement Project (SCIP) guidelines. Infection was defined as symptoms of vaginal infection, postoperative abscess, wound breakdown, or cellulitis confirmed with physical exam or laboratory results within 6 weeks from date of surgery. Student T-Test and Wilcoxon Rank Test were used to identify the differences between continuous demographic variables, and Chi-squared test χ2 was used to identify the differences between categorical variables. Multivariate logistic regression was built for binary outcomes. Odds ratio (OR) and 95 % confidence intervals (CI) are reported.

Results: 859 patients were included in this review, with 423 at Site A and 436 at Site B. Mean patient age was similar between Site A and B (62 vs 61 years, p=0.027), while patients at Site A had a higher BMI (29 vs. 27kg/m²; p< 0.001). Patients at Site A had fewer hysterectomies (28% vs. 37%; p< 0.05), posterior repairs (65% vs. 74%; p< 0.05) and apical repairs (22% vs. 51%; p< 0.001) compared to patients in the Site B cohort. Cefazolin was the predominant antibiotic used for prophylaxis at both sites, however 49% of patients at Site A site vs 4 % in Site B received metronidazole in addition to cefazolin (p < 0.001) [Table 1]. 3% patients who underwent vaginal urogynecologic surgery with safety bundles at Site A developed an infection vs. 12% patients in the Site B using SCIP guidelines (p < 0.001). Multivariate modeling after adjusting for demographics, smoking status, comorbid conditions, antibiotics, and procedures showed that patients who had surgeries at Site A were at lower odds of developing overall infections when compared to Site B (OR = 0.31; 95% CI [0.14 – 0.72]; p=0.01. Additionally, patients who had iodine vaginal preparation were four times more likely to develop overall infection compared to those with vaginal chlorohexidine preparation (OR = 4.49; 95%CI [1.52 – 13.26]; p=0.01).

Conclusions: Patients who underwent urogynecologic vaginal surgery where an SSI prevention bundle was implemented had lower rates of SSI when compared to sites who adhered to SCIP guidelines.