Risk of infection after midurethral synthetic sling surgery: are postoperative antibiotics necessary?

Objectives: To review our postoperative infections using single-dose preoperative antibiotics. Midurethral synthetic sling surgery is commonly performed. Postoperative antibiotics are often prescribed and may have some risk of adverse events (AEs). We are unaware of data suggesting decreased risk of infection with this practice.

Methods: We reviewed all midurethral synthetic sling surgery charts from 2004 to 2008 performed by 1 surgeon who uses only single-dose preoperative antibiotics (controls), and 2 who also use postoperative antibiotics(cases). A telephone survey was administered, which included questions regarding postoperative infections and AEs related to antibiotic use. Our primary and secondary outcomes were urinary tract infections (UTIs) and AEs related to antibiotic use, respectively. Patients were excluded for bladder injuries, postoperative catheters, and concomitant prolapse surgery.

Results: We identified 103 cases and 116 controls, and the telephone survey response rate was 81.3%. At baseline, groups had similar characteristics. There was no significant difference in UTIs between cases (6.8%) and controls (9.5%). There were no skin infections. AEs related to antibiotic use were more common among those that received postoperative antibiotics (7.8% vs 0.9%, P=.03). There were 5 (63%) yeast infections, 1 (12.5%) rash, 1 (12.5%) case of nausea, and 1 (12.5%) patient with colitis among cases and 1 yeast infection among controls.

Conclusions: UTI is common after sling surgery, but other infections are rare. The occurrence of UTI does not appear to be lower when postoperative antibiotics are prescribed. However, AEs associated with antibiotic use are increased. These findings do not support the use of postoperative antibiotics.