Gynecological Laparoscopies Show Unexpectedly High Infection Rate

By David Douglas

July 22, 2020

NEW YORK (Reuters Health) - Surgical site infections (SSIs) are seen in almost one in six patients who undergo gynecological laparoscopy, according to Israeli and Australian researchers.

Dr. Uri P. Dior told Reuters Health by email "Our study, that was the first to prospectively assess rates of infections after one of the most common surgical procedures worldwide -- gynecological laparoscopies - has shown higher rates of infections than previously thought."

In an online paper in JAMA Surgery, Dr. Dior of Hadassah-Hebrew University Medical Center, Jerusalem, and colleagues note that there is limited evidence on strategies to prevent such infections.

To investigate further, the researchers studied 661 women who underwent an elective laparoscopy for treatment of nonmalignant gynecological disorders. They were randomized to have their skin cleaned before surgery with alcohol-based chlorhexidine, alcohol-based povidone-iodine, or water-based povidone-iodine.

Patients were blinded to the solution as were physicians who conducted follow-up examinations on 640 available participants at one and four weeks after surgery.

In modified intention-to-treat analysis including only these 640 patients, the overall rate of port-site infection was 10.2%. For organ or space infection, the proportion was 6.6% and for any surgical site infection it was 16.3%.

No significant differences in the odds of total and specific types of SSIs were observed when comparing solutions containing iodine with chlorhexidine.The odds ratio for port-site infection for alcohol-based chlorhexidine vs water-based povidone-iodine was 1.13. For alcohol-based chlorhexidine vs alcohol-based povidone-iodine, the odds ratio was 1.34 and for water-based povidone-iodine vs alcohol-based povidone-iodine, it was 1.19.

These findings, Dr. Dior concluded, "warrant awareness by gynecologists and primary care physicians, as well as more research to explore ways to reduce infection rates and their health burden."

Among possible measure he and his colleagues suggest are routine bathing or cleaning, specific preparation of the umbilicus, and an antibiotic prophylaxis protocol.

Commenting by email, Dr. Vincenzo Berghella, professor of Obstetrics & Gynecology and Director of the Division of Maternal-Fetal Medicine at Thomas Jefferson University, Philadelphia, characterized the study as being "a good randomized trial."

But, he added, "The sample size -- number of patient-enrolled -- is probably not big enough to answer the question. More research is needed."

SOURCE: JAMA Surgery, online July 8, 2020.