Surgical Site Infection After Sacral Neuromodulation: Impact of Postoperative Antibiotics

Luke J King; Sarah L Ashmore; Hannah L Chapman; Collin M McKenzie; Bayley E Clarke; Sarah K Rozycki; Rodger W Rothenberger; Jared M Floch; Nageena R Khalid; Brittany L Roberts; Mildred N Bonglack; Charles R Rardin

doi:10.1097/SPV.0000000000001627

Surgical Site Infection After Sacral Neuromodulation: Impact of Postoperative Antibiotics

Urogynecology (Phila). 2024 Dec 31. doi: 10.1097/SPV.0000000000001627. Online ahead of print.

Authors

Affiliations

¹ From the Division of Urogynecology and Reconstructive Pelvic Surgery at the Women and Infants Hospital, Providence, RI.
² Division of Urogynecology and Reconstructive Pelvic Surgery at the University of Chicago, Chicago, IL.
³ Division of Urogynecology and Reconstructive Pelvic Surgery at the University of Alabama, Birmingham, AL.
⁴ Department of Women's Health at the University of Texas at Austin, Austin, TX.
⁵ Division of Urogynecology at the MedStar Washington Hospital Center, Washington, DC.
⁶ Division of Urogynecology at the Houston Methodist Hospital, Houston, TX.
⁷ Division of Urogynecology at University of Louisville, Louisville, KY.
⁸ Division of Pelvic Health and Urogynecology at the University of Rochester Medical Center, Rochester, NY.
⁹ Research Department of Women and Infants Hospital, Providence, RI.
¹⁰ Division of Female Pelvic Medicine & Reconstructive Surgery at the Albany Medical Center, Albany, NY.
¹¹ Division of Urogynecology, Female Pelvic Medicine and Reconstructive Surgery at the Good Samaritan Hospital, Cincinnati, OH.

PMID: 39787541
DOI: 10.1097/SPV.0000000000001627

Abstract

Importance: There are limited data to guide practices to reduce surgical site infections following sacral neuromodulation; however, many surgeons prescribe prophylactic postoperative antibiotics after device implantation.

Objective: The aim of the study was to compare the proportion of patients with sacral neuromodulation device-associated surgical site infections after use of prophylactic postoperative antibiotics versus none.

Study design: This was a multicenter retrospective cohort study of patients undergoing sacral neuromodulation device implantation at 11 institutions from January 2014 to December 2023, comparing outcomes in patients who did versus did not receive prophylactic postoperative antibiotic treatment. The primary outcome was surgical site infection within 90 days. The proportions of surgical site infections were compared, and regression analyses were performed to identify variables associated with surgical site infection.

Results: A total of 1,798 patients met inclusion criteria. Within this population, 67 surgical site infections (3.7%) were identified. Patients who received postoperative antibiotics (898/1798, 49.9%) were older (63.2 years vs 61.0 years, P < 0.001), and a greater proportion had staged procedures (57.9% vs 49.8%, P < 0.001). The proportion of surgical site infections and device explantations were not different between groups (3.6% vs 3.9%, P = 0.8) and (2.0% vs 2.8%, P = 0.2), respectively. After adjusting for age in a multivariate analysis, prophylactic postoperative antibiotic use was not associated with surgical site infections (0.98, 95% CI: 0.61-1.61, P = 0.94).

Conclusions: Rates of surgical site infection following device implantation are low. Our findings suggest that the use of prophylactic postoperative antibiotics has minimal effect on reducing infection after device implantation. Further research is needed to explore underlying factors influencing this relationship.