Postoperative Antibiotics After Sacral Neuromodulation Stimulator Implantation

Friday, October 25, 2024

3:16 PM – 3:20 PM EDT

Location: Liberty Ballroom (Meeting Level 4)

Table 1. Demographics, Surgical Characteristics, and Postoperative Findings

Table 1_IPG ABX Study_King_04102024.docx

Table 2. Variables Associated with SSI According to Univariate and Multivariate Logistic Regression

Table 2_IPG ABX Study_King04102024.docx

Objectives: There are limited data to guide practices to reduce surgical site infections (SSIs) following implantable pulse generator (IPG) implantation; however, many surgeons prescribe prophylactic postoperative antibiotics. The primary objective was to compare the proportion of patients with SSIs after exposure to postoperative prophylactic antibiotics versus none. The secondary objective was to compare proportion of SSI-associated IPG explantations between groups.

Methods: Retrospective cohort study of adult patients undergoing IPG implantation at 11 institutions from January 2014 to December 2023, comparing outcomes in patients who did versus did not receive postoperative prophylactic antibiotic treatment. Patients were identified using Current Procedural Terminology codes, and study variables were extracted by chart review. Postoperative prophylactic antibiotics use was defined as exposure to any systemic antibiotic prescribed immediately following implantation. Patients being treated with antibiotics for concomitant infection were excluded. The primary outcome was SSI within 60 days, as defined by Center for Disease Control criteria of superficial incisional, deep incisional, or organ/space infection. The proportions of SSIs were compared and regression analyses were performed to identify variables associated with SSI. In order to detect a 3.5% reduction in SSIs in the exposure group (9.0% vs 6.5%) with a power of 80% and error probability of 0.05, 1442 patients (721 patients in each group) were required.

Results: A total of 1798 patients met inclusion criteria with 67 SSIs (3.7%) identified. Median antibiotic duration was 7 days, and antimicrobial agents varied widely. Patients who received antibiotics (898/1798, 49.9%) were older (63.2 yrs vs 61.0 yrs, p < 0.001), and a greater proportion had staged procedure (57.9% vs 49.8%, p < 0.001). Intraoperative antibiotic irrigation (70.8% v 53.0%, p< 0.001) and antiseptic envelope use (15.3% vs 5.3%, p< 0.001) were higher in exposure group, with additional differences noted in Table 1. The groups were otherwise comparable, specifically with no significant differences noted between skin preparation, pocket site relative to lead site, depth of implant in cm, anticoagulation use, blood loss, procedure duration, and hematoma formation. The proportion of SSIs was not different between groups (3.6% vs 3.9%, p=0.8). SSI-associated IPG explantations was not different between groups (2.0% vs 2.8%, p=0.2). Variables associated with SSI are noted in Table 2. Due to low number of SSIs, only age and postoperative antibiotic use were included in multivariate analysis. After adjusting for age, postoperative prophylactic antibiotic use was not associated with SSI (0.98, 95% CI: 0.96-0.99, p=0.94). Methicillin-sensitive Staphylococcus was the most commonly identified organism (44%) associated with SSI.

Conclusions: Postoperative prophylactic antibiotic use following IPG implantation was not associated with a decrease in SSIs in this cohort. The number of SSI after IPG is low whether postoperative prophylactic antibiotics are used or not.

Disclosure(s):

Luke King, DO: No financial relationships to disclose

Sarah Ashmore, MD: No financial relationships to disclose

Hannah L. Chapman, MD: No financial relationships to disclose

Collin M. McKenzie, MD: No financial relationships to disclose

Bayley Clarke, MD: No financial relationships to disclose

Sarah K. Rozycki, MD: No financial relationships to disclose

Rodger W. Rothenberger, MD: No financial relationships to disclose

Jared M. Floch, DO, MS: No financial relationships to disclose

Nageena Khalid, MPH: No financial relationships to disclose

Brittany Roberts, MD: No financial relationships to disclose

Mildrede Bonglack, MD: No financial relationships to disclose

Charles R. Rardin, MD, FACOG, FACS: No relevant disclosure to display

Presenting Author(s)

Luke King, DO (he/him/his)

Fellow
Brown - Warren Alpert School of Medicine
North Attleboro, Massachusetts, United States

Disclosure(s): No financial relationships to disclose

Co-Author(s)

Sarah Ashmore, MD

Fellow
Section Urogynecology and Reconstructive Pelvic Surgery, University of Chicago
Chicago, Illinois, United States

Disclosure(s): No financial relationships to disclose
Hannah L. Chapman, MD (she/her/hers)

Fellow/ Clinical instructor
University of Alabama at Birmingham
Birmingham, Alabama, United States

Disclosure(s): No financial relationships to disclose
Collin M. McKenzie, MD

Fellow
Department of Women's Health, Dell School of Medicine, University of Texas at Austin
Pflugerville, Texas, United States

Disclosure(s): No financial relationships to disclose
Bayley Clarke, MD (she/her/hers)

Fellow
MedStar Washington Hospital Center
Washington, District of Columbia, United States

Disclosure(s): No financial relationships to disclose
Sarah K. Rozycki, MD (she/her/hers)

Fellow
Houston Methodist Hospital
Houston, Texas, United States

Disclosure(s): No financial relationships to disclose
Rodger W. Rothenberger, MD (he/him/his)

FPMRS Fellow
The University of Louisville Medical Center
Cincinnati, Ohio, United States

Disclosure(s): No financial relationships to disclose
Jared M. Floch, DO, MS (he/him/his)

Urogynecology and Reconstructive Pelvic Surgery Fellow
University of Rochester Medical Center
Rochester, New York, United States

Disclosure(s): No financial relationships to disclose
NK

Nageena Khalid, MPH

Research Statistician
Womens and Infants Hospital
Tucson, Arizona, United States

Disclosure(s): No financial relationships to disclose
Brittany Roberts, MD

Urogynecology Fellow
Albany Medical Center
Albany, New York, United States

Disclosure(s): No financial relationships to disclose
MB

Mildrede Bonglack, MD

FPMRS fellow
Good Samaritan Hospital/TriHealth
Cincinnati, Ohio, United States

Disclosure(s): No financial relationships to disclose
CR

Charles R. Rardin, MD, FACOG, FACS

Director, Division of Urogynecology and Reconstructive Surgery
Alpert Medical School of Brown University
Providence, Rhode Island, United States

Disclosure(s): No relevant disclosure to display