Topical Hemostatic Agents and the Risk of Pelvic Infection in Gynecologic Surgery

STUDY OBJECTIVE: As hemostatic agent use becomes routine, adverse effects must be assessed, including infection. This study compared pelvic infection following the use of different hemostatic agents.

DESIGN: Pelvic infection within 6 weeks of surgery was assessed in a retrospective cohort study, with a sub-analysis for hysterectomies. Fisher's Exact test was used to compare cases.

SETTING: This study was conducted at a large midwestern hospital.

PATIENTS: Patients who underwent benign gynecologic surgeries where a hemostatic agent was used from 2009 to 2019, excluding those who are under 18 years old, pregnant, had coagulopathies, malignancy, or plasma allergies.

INTERVENTIONS: This study evaluates benign gynecologic surgeries with hemostatic agent use.

MAIN RESULTS: Among 3,206 surgeries, biologic agents were used most frequently (54.7%), followed by mechanical (41.7%) and combined agents (3.6%). Biologic agents had the lowest infection rate (0.3%) compared with mechanical (1.0%) and combined agents (1.8%; p=.023). Absorbable gelatin sponge use was associated with the highest infection rate overall (7.8% vs 0.5%; p<.001) and in hysterectomy cases (4.3% vs 0.3%; p=.003). Thrombin-fibrinogen agents were associated with lower infection rates overall (0.4% vs 1.1%; p=.018), though this was not significant in the hysterectomy sub-analysis (p=.22). After adjusting for patient and surgical factors, laparoscopic, robotic, and hysterectomy procedures were associated with lower infection odds compared with open and non-hysterectomy approaches. Operative time was independently associated with infection.

CONCLUSION: Careful use of hemostatic agents may lower infection risk. Risk appears higher with mechanical and combined agents than with biologic agents. The absorbable gelatin sponge may carry a higher risk of infection.