Febrile and Infectious Morbidity After Laparotomy for Ectopic Pregnancy: Potential for Antibiotic Prophylaxis

Antibiotic prophylaxis has been used extensively for obstetric and gynecologic surgical procedures. However, it has not been evaluated for removal of an ectopic pregnancy. This retrospective pilot study was conducted to determine if significant infectious morbidity occurs after laparotomy for ectopic pregnancy to warrant a randomized, prospective trial of antibiotic prophylaxis. During a 1-year period, 42.9% of 49 women undergoing laparotomy for ectopic pregnancy had postoperative febrile morbidity, and 22.4% had postoperative infections requiring antibiotics. The groups with and without febrile morbidity were similar with respect to multiple parameters, including age, weight, medical and surgical history, laboratory data, and operative time. Patients with febrile morbidity were more commonly smokers (p < 0.05) and had greater estimated blood loss (p < 0.05) at surgery. The patients with postoperative febrile morbidity had a significantly increased mean hospital stay (p < 0.05) compared with those who were afebrile, 6.29 ± 0.40 days vs 4.89 ± 0.17 days, respectively. The subgroup of patients with postoperative infections accounted for this increase in hospital stay. We conclude that there is significant postoperative morbidity following laparotomy for ectopic pregnancy. Although smoking and increased blood loss appear to be associated factors, whether or not they are causal remains to be determined by a prospective, randomized, controlled study. (J GYNECOL SURG 6:161, 1990)