Incidence and Risk Factors for Perioperative Infections After Robot‐Assisted Radical Prostatectomy: A Multicenter Study
Takuhisa Nukaya, Kiyohito Ishikawa, Takuya Sadahira, Takanori Sekito, Hironori Betsunoh, Koki Maeda, Kosuke Shibahara, Yoshiki Hiyama, Jun Kamei, Kimihiro Shimatani, Hiroyuki Kitano, Satoshi Ishitoya, Koichiro Wada, Katsumi Shigemura, Tohru Nakagawa, Jun Miyazaki, Takao Kamai, Ryoichi Shiroki, Shingo Yamamoto, Satoshi Takahashi,ABSTRACT
Objectives
To evaluate the incidence, antimicrobial prophylaxis patterns, and risk factors for perioperative infections after robot‐assisted radical prostatectomy (RARP) in a large Japanese multicenter cohort.
Methods
We retrospectively analyzed 6660 patients who underwent RARP between 2009 and 2021 and received Japanese Urological Association guideline‐recommended prophylaxis with cefazolin (CEZ), ampicillin/sulbactam (ABPC/SBT), or second‐generation cephalosporins (2ndCPs). Surgical site infection (SSI), urinary tract infection (UTI), and remote infection (RI) within 30 postoperative days were assessed. Infection rates were compared according to antibiotic regimen and duration (≤ 24 vs. > 24 h), and risk factors were evaluated using logistic regression.
Results
CEZ, ABPC/SBT, and 2ndCPs were administered to 4321 (64.9%), 1501 (22.7%), and 838 (12.6%) patients, respectively. Overall incidences of SSI, UTI, and RI were 1.2%, 1.4%, and 0.3%, respectively. SSI was mainly superficial, whereas deep or organ/space SSI was rare. No significant differences in SSI incidence were observed between ≤ 24‐ and > 24‐h administration within each regimen. Multivariate analysis identified bowel injury as an independent risk factor for SSI. For UTI, body mass index (BMI) ≥ 30 kg/m 2 , leakage at catheter removal, indwelling catheterization ≥ 8 days, and ABPC/SBT use were associated factors.
Conclusions
Perioperative infection rates after RARP were low. Prophylaxis within 24 h, particularly with CEZ or 2ndCPs, may be sufficient. Prevention of bowel injury and appropriate catheter management may further reduce postoperative infections.