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Sources of Funding: University of Chicago Institute of Translational Medicine, Core subsidy grant

Introduction

Although frequently prescribed, the role of postoperative oral antibiotics in preventing artificial urinary sphincter (AUS) explant is unknown. We aimed to determine whether postoperative oral antibiotics are associated with decreased risk of explantation following AUS.

Methods

We queried the MarketScan database (a large national, prospectively-maintained database of private insurance claims) to identify male patients undergoing AUS placement between 2003 and 2014. The primary endpoint was AUS explantation, determined by CPT codes. Multivariate regression analysis assessed for independent predictors of explantation, including peri- and postoperative antibiotic administration.

Results

We identified 3594 patients who underwent AUS placement at mean age 68.1 years (±0.15). 141 of 3594 (3.9%) patients underwent AUS explant at a median 41.5 days (IQR 20-61) after index surgery. Rates of explant stratified by risk factors are detailed in Table 1. On multivariate regression analysis, controlling for age and multiple previously described comorbid risk factors, we identified age >75 years, diagnosis of diabetes, and Charlson comorbidity index >1 to be independently associated with AUS explant (Table 1). The 2300 patients (64%) who received postoperative oral antibiotics did not experience any reduction in explant rate relative to those not receiving postoperative oral antibiotics (3.91% vs 3.95%, adjusted OR 1.01, 95% CI 0.71-1.45). Explant rates were similar among the approximately one-quarter of patients for whom perioperative IV antibiotic data were available, with no difference in explant rates observed for the 64% of patients receiving an antibiotic regimen consistent with AUA guidelines (4.5% vs 4.3%, p=0.89).

Conclusions

Postoperative oral antibiotics are prescribed to nearly two-thirds of patients but are not associated with reduced risk of explant following AUS placement. Given the risks to individuals associated with use of antibiotics and increasing bacterial resistance, routine use of oral antibiotics after AUS should be reconsidered.

Funding

University of Chicago Institute of Translational Medicine, Core subsidy grant