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

Abstract 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.