Association Between Gelatin-Thrombin Matrix Use and Abscesses in Women Undergoing Pelvic Surgery

Abstract

Gynecologists commonly use hemostatic agents to control intraoperative bleeding during pelvic surgery, thereby avoiding more significant intervention. However, hemostatic agents predispose patients to infection. They appear to cause a probiotic microenvironment and impair host-defense mechanisms that contribute to bacterial proliferation and abscess formation. The primary aim of this study was to assess the association between use of gelatin-thrombin matrix and the occurrence of pelvic abscess during hysterectomy. Another aim was to investigate predictive factors for abscess formation. Data were abstracted from records of patients undergoing hysterectomy for obstetric-gynecologic pathology at a tertiary hospital between 2009 and 2012. Open, laparoscopic, robotic, and laparoscopic-assisted hysterectomies were included; vaginal hysterectomies were excluded. Charts were reviewed for surgery type, blood loss, preoperative comorbidities, drain placement, use of gelatin-thrombin matrix for bleeding, and abscess formation. The primary study outcome was pelvic abscess defined according to the following criteria: a walled-off fluid collection (observed with computed tomography scan) with fever (>38°C) or leukocytosis (>11,000/μL). Among 413 patients meeting study criteria; 213 (51%) underwent surgery for malignancy, and 166 (40%) were treated with gelatin-thrombin matrix. The rate of pelvic abscess was low (3%); nearly all abscesses occurred in patients in whom gelatin-thrombin matrix was used. Bivariate analyses showed that the following were associated with abscess formation: blood loss greater than 500 mL (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.1–12.9; P = 0.021), ascites (OR, 6.5; 95% CI, 1.6–26.1; P = 0.023), drain placement (OR, 4.5; 95% CI, 1.3–5.1; P = 0.009), and use of gelatin-thrombin matrix (OR, 7.0, 95% CI, 1.5–32.9; P = 0.009). In multivariable logistic regression, only gelatin-thrombin matrix use was a predictive factor for abscess formation (OR, 7.0; 95% CI, 1.5–32.9; P = 0.013). These data suggest that the liberal use of gelatin-thrombin matrix to control intraoperative hemorrhage in patients undergoing hysterectomy is not without risk. Further studies are needed to determine the true risk of abscess formation in this population and to compare the risk of abscess with that of other hemostatic agents.