TOPLINE

Among women who underwent hysterectomy for benign disease, BMI of 40 or above, the preoperative use of immunoregulatory drugs, and endometriosis were associated with a higher risk for postoperative antibiotic dispensing, a surrogate marker of infection. Perioperative complications showed the strongest association. However, the surgical approach showed no significant association.

METHODOLOGY

• Using data from four linked Swedish national registries, researchers conducted a population-based cohort study to assess factors associated with postoperative infections after hysterectomy for benign disease.
• They analysed data of 50,601 women who underwent hysterectomies for benign disease between 2005 and 2022.
• Hysterectomy was performed using abdominal, laparoscopic, robot-assisted laparoscopic, or vaginal approaches.
• Infections after surgery were approximated by any systemic antibiotic dispensed within 21 days, a surrogate marker considered reasonable in Sweden because antibiotics are not routinely given after surgery to prevent infections.

TAKEAWAY

• Overall, postoperative antibiotics were dispensed in 14.1% of women.
• After adjustment, BMI of 40 or above (adjusted risk ratio [aRR], 1.42), endometriosis (aRR, 1.30), the use of immunomodulatory drugs before surgery (aRR, 1.48), psycholeptic stimulators (aRR, 1.29), cardiac or hypertensive drugs (aRR, 1.24), antidepressants (aRR, 1.15), prior caesarean section (aRR, 1.09), and prior abdominal surgery (aRR, 1.24) were significantly associated with a higher risk for dispensed postoperative antibiotics.
• Perioperative complications emerged as the strongest predictor, associated with more than twice the risk for dispensed postoperative antibiotics (aRR, 2.19).
• The surgical approach and uterine weight did not show an association with the risk for dispensed postoperative antibiotics after adjustment for perioperative events.

IN PRACTICE

"Our study highlights important risk factors for dispensed antibiotics following hysterectomy, emphasizing the need for vigilance pre- and postoperatively," the authors wrote.

"Integrating these risk factors into preoperative risk assessment may help identify women at increased likelihood of postoperative infectious morbidity and guide tailored prophylactic and perioperative strategies to reduce infection rates," they added.

SOURCE

This study was led by Sophia Ehrström, Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. It was published online on October 05, 2026, in Acta Obstetricia et Gynecologica Scandinavica.

LIMITATIONS

Although the registry information was collected prospectively, the analysis was conducted retrospectively. The study could not determine whether all antibiotic prescriptions issued after surgery were related to postoperative infections.

DISCLOSURES

This study received support through grants from the Stig and Ragna Gorthon Foundation. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.