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Prophylactic antibiotics for myomectomy?
In the 1990s, researchers found that patients undergoing any type of surgical procedure were more than twice as likely to die if they developed postsurgical infection.1 Work to reduce surgical site infection (SSI) has and does continue, with perioperative antibiotics representing a good part of that effort. The American College of Obstetricians and Gynecologists currently recommends such antibiotic therapy for women undergoing laparotomy and laparoscopic hysterectomy.2 ACOG does not, however, recommend prophylactic antibiotics for myomectomy procedures.3 Rates of infection for hysterectomy have been reported to be 3.9% for abdominal and 1.4% for minimally invasive approaches.4
To determine the current use of antibiotics during myomectomy and associated rates of SSI at their institutions, Dipti Banerjee, MD, and colleagues conducted a retrospective analysis of women undergoing laparoscopic or abdominal myomectomy between February 2013 and December 2017 at the University of California, Los Angeles and Hoag Memorial Hospital in Orange County, California. They presented their study results at AAGL’s 49th Global Congress on MIGS, held virtually November 6-14, 2020.3
Rate of SSI after myomectomy
A total of 620 women underwent laparoscopic myomectomy and 563 underwent open myomectomy during the study period. Antibiotics were used in 76.9% of cases. SSI developed within 6 weeks of surgery in 34 women (2.9%) overall. The women undergoing abdominal myomectomy without antibiotics were more likely to experience SSI than the women who received antibiotics (odds ratio [OR], 4.89; confidence interval [CI], 1.80–13.27; P = .0006). For laparoscopic myomectomy, antibiotic use did not affect the odds of developing SSI (OR, 1.08; CI, 0.35–3.35).
Antibiotics were more likely to be used in certain cases
Antibiotics were more likely to be administered for patients who:
- were obese (body mass index ≥30 kg/m2) (P = .009)
- underwent previous abdominal surgery (P = .001)
- underwent laparotomy (P <.0001)
- had endometrial cavity entry (P <.0001)
- had >1 fibroid (P = .0004) or an aggregate fibroid weight >500 g (P <.0001).
More data on antibiotics for myomectomy
In a retrospective study conducted at 2 academic hospitals in Boston, Massachusetts, 1,211 women underwent myomectomy from 2009 to 2016. (Exclusions were use of vaginal or hysteroscopic myomectomy, chromopertubation, or conversion to hysterectomy.) More than 92% of the women received perioperative antibiotics at the time of surgery. Although demographics were similar between women receiving and not receiving antibiotics, women who received antibiotics were more likely to have longer operative times (median 140 vs 85 min), a greater myoma burden (7 vs 2 myomas removed and weight 255 vs 53 g), and lose blood during the procedure (137 vs 50 mL). These women also were 4 times less likely to have surgical site infection (adjusted OR, 3.77; 95% CI, 1.30–10.97; P = .015).5,6
Banerjee and colleagues say that their California study demonstrates “that the majority of surgeons elect to use antibiotics prophylactically” during myomectomy, despite current ACOG guidelines, and that their findings of benefit for abdominal myomectomy but not for laparoscopic myomectomy should inform future guidance on antibiotics for myomectomy surgery.3
- Kirkland KB, Briggs JP, Trivette SL, et al. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20:725-730.
- American College of Obstetricians and Gynecologists. Practice Bulletin No. 195: prevention of infection after gynecologic procedures. Obstet Gynecol. 2018;131:e172-e189.
- Banerjee D, Dejbakhsh S, Patel HH, et al. Perioperative antibiotic prophylaxis in myomectomy surgery. Paper presented at 49th Annual Meeting of the AAGL; November 2020.
- Uppal S, Harris J, Al-Niaimi A. Prophylactic antibiotic choice and risk of surgical site infection after hysterectomy. Obstet Gynecol. 2016;127:321-329.
- Kim AJ, Clark NV, Jansen LJ, et al. Perioperative antibiotic use and associated infectious outcomes at the time of myomectomy. Obstet Gynecol. 2019;133:626-635.
- Rebar RW. Should perioperative antibiotics at myomectomy be universal? NEJM J Watch. March 11, 2019.
In the 1990s, researchers found that patients undergoing any type of surgical procedure were more than twice as likely to die if they developed postsurgical infection.1 Work to reduce surgical site infection (SSI) has and does continue, with perioperative antibiotics representing a good part of that effort. The American College of Obstetricians and Gynecologists currently recommends such antibiotic therapy for women undergoing laparotomy and laparoscopic hysterectomy.2 ACOG does not, however, recommend prophylactic antibiotics for myomectomy procedures.3 Rates of infection for hysterectomy have been reported to be 3.9% for abdominal and 1.4% for minimally invasive approaches.4
To determine the current use of antibiotics during myomectomy and associated rates of SSI at their institutions, Dipti Banerjee, MD, and colleagues conducted a retrospective analysis of women undergoing laparoscopic or abdominal myomectomy between February 2013 and December 2017 at the University of California, Los Angeles and Hoag Memorial Hospital in Orange County, California. They presented their study results at AAGL’s 49th Global Congress on MIGS, held virtually November 6-14, 2020.3
Rate of SSI after myomectomy
A total of 620 women underwent laparoscopic myomectomy and 563 underwent open myomectomy during the study period. Antibiotics were used in 76.9% of cases. SSI developed within 6 weeks of surgery in 34 women (2.9%) overall. The women undergoing abdominal myomectomy without antibiotics were more likely to experience SSI than the women who received antibiotics (odds ratio [OR], 4.89; confidence interval [CI], 1.80–13.27; P = .0006). For laparoscopic myomectomy, antibiotic use did not affect the odds of developing SSI (OR, 1.08; CI, 0.35–3.35).
Antibiotics were more likely to be used in certain cases
Antibiotics were more likely to be administered for patients who:
- were obese (body mass index ≥30 kg/m2) (P = .009)
- underwent previous abdominal surgery (P = .001)
- underwent laparotomy (P <.0001)
- had endometrial cavity entry (P <.0001)
- had >1 fibroid (P = .0004) or an aggregate fibroid weight >500 g (P <.0001).
More data on antibiotics for myomectomy
In a retrospective study conducted at 2 academic hospitals in Boston, Massachusetts, 1,211 women underwent myomectomy from 2009 to 2016. (Exclusions were use of vaginal or hysteroscopic myomectomy, chromopertubation, or conversion to hysterectomy.) More than 92% of the women received perioperative antibiotics at the time of surgery. Although demographics were similar between women receiving and not receiving antibiotics, women who received antibiotics were more likely to have longer operative times (median 140 vs 85 min), a greater myoma burden (7 vs 2 myomas removed and weight 255 vs 53 g), and lose blood during the procedure (137 vs 50 mL). These women also were 4 times less likely to have surgical site infection (adjusted OR, 3.77; 95% CI, 1.30–10.97; P = .015).5,6
Banerjee and colleagues say that their California study demonstrates “that the majority of surgeons elect to use antibiotics prophylactically” during myomectomy, despite current ACOG guidelines, and that their findings of benefit for abdominal myomectomy but not for laparoscopic myomectomy should inform future guidance on antibiotics for myomectomy surgery.3
In the 1990s, researchers found that patients undergoing any type of surgical procedure were more than twice as likely to die if they developed postsurgical infection.1 Work to reduce surgical site infection (SSI) has and does continue, with perioperative antibiotics representing a good part of that effort. The American College of Obstetricians and Gynecologists currently recommends such antibiotic therapy for women undergoing laparotomy and laparoscopic hysterectomy.2 ACOG does not, however, recommend prophylactic antibiotics for myomectomy procedures.3 Rates of infection for hysterectomy have been reported to be 3.9% for abdominal and 1.4% for minimally invasive approaches.4
To determine the current use of antibiotics during myomectomy and associated rates of SSI at their institutions, Dipti Banerjee, MD, and colleagues conducted a retrospective analysis of women undergoing laparoscopic or abdominal myomectomy between February 2013 and December 2017 at the University of California, Los Angeles and Hoag Memorial Hospital in Orange County, California. They presented their study results at AAGL’s 49th Global Congress on MIGS, held virtually November 6-14, 2020.3
Rate of SSI after myomectomy
A total of 620 women underwent laparoscopic myomectomy and 563 underwent open myomectomy during the study period. Antibiotics were used in 76.9% of cases. SSI developed within 6 weeks of surgery in 34 women (2.9%) overall. The women undergoing abdominal myomectomy without antibiotics were more likely to experience SSI than the women who received antibiotics (odds ratio [OR], 4.89; confidence interval [CI], 1.80–13.27; P = .0006). For laparoscopic myomectomy, antibiotic use did not affect the odds of developing SSI (OR, 1.08; CI, 0.35–3.35).
Antibiotics were more likely to be used in certain cases
Antibiotics were more likely to be administered for patients who:
- were obese (body mass index ≥30 kg/m2) (P = .009)
- underwent previous abdominal surgery (P = .001)
- underwent laparotomy (P <.0001)
- had endometrial cavity entry (P <.0001)
- had >1 fibroid (P = .0004) or an aggregate fibroid weight >500 g (P <.0001).
More data on antibiotics for myomectomy
In a retrospective study conducted at 2 academic hospitals in Boston, Massachusetts, 1,211 women underwent myomectomy from 2009 to 2016. (Exclusions were use of vaginal or hysteroscopic myomectomy, chromopertubation, or conversion to hysterectomy.) More than 92% of the women received perioperative antibiotics at the time of surgery. Although demographics were similar between women receiving and not receiving antibiotics, women who received antibiotics were more likely to have longer operative times (median 140 vs 85 min), a greater myoma burden (7 vs 2 myomas removed and weight 255 vs 53 g), and lose blood during the procedure (137 vs 50 mL). These women also were 4 times less likely to have surgical site infection (adjusted OR, 3.77; 95% CI, 1.30–10.97; P = .015).5,6
Banerjee and colleagues say that their California study demonstrates “that the majority of surgeons elect to use antibiotics prophylactically” during myomectomy, despite current ACOG guidelines, and that their findings of benefit for abdominal myomectomy but not for laparoscopic myomectomy should inform future guidance on antibiotics for myomectomy surgery.3
- Kirkland KB, Briggs JP, Trivette SL, et al. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20:725-730.
- American College of Obstetricians and Gynecologists. Practice Bulletin No. 195: prevention of infection after gynecologic procedures. Obstet Gynecol. 2018;131:e172-e189.
- Banerjee D, Dejbakhsh S, Patel HH, et al. Perioperative antibiotic prophylaxis in myomectomy surgery. Paper presented at 49th Annual Meeting of the AAGL; November 2020.
- Uppal S, Harris J, Al-Niaimi A. Prophylactic antibiotic choice and risk of surgical site infection after hysterectomy. Obstet Gynecol. 2016;127:321-329.
- Kim AJ, Clark NV, Jansen LJ, et al. Perioperative antibiotic use and associated infectious outcomes at the time of myomectomy. Obstet Gynecol. 2019;133:626-635.
- Rebar RW. Should perioperative antibiotics at myomectomy be universal? NEJM J Watch. March 11, 2019.
- Kirkland KB, Briggs JP, Trivette SL, et al. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20:725-730.
- American College of Obstetricians and Gynecologists. Practice Bulletin No. 195: prevention of infection after gynecologic procedures. Obstet Gynecol. 2018;131:e172-e189.
- Banerjee D, Dejbakhsh S, Patel HH, et al. Perioperative antibiotic prophylaxis in myomectomy surgery. Paper presented at 49th Annual Meeting of the AAGL; November 2020.
- Uppal S, Harris J, Al-Niaimi A. Prophylactic antibiotic choice and risk of surgical site infection after hysterectomy. Obstet Gynecol. 2016;127:321-329.
- Kim AJ, Clark NV, Jansen LJ, et al. Perioperative antibiotic use and associated infectious outcomes at the time of myomectomy. Obstet Gynecol. 2019;133:626-635.
- Rebar RW. Should perioperative antibiotics at myomectomy be universal? NEJM J Watch. March 11, 2019.