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Preoperative Vaginal Metronidazole Decreases the Risk of Pelvic Infections After Radical Robotic Hysterectomy
  1. Monica Avila, MD*,
  2. Jared R. Funston, MD,
  3. Allison A. Axtell, MD and
  4. Scott E. Lentz, MD
  1. *Departments of Obstetrics and Gynecology, and
  2. General Surgery, Huntington Memorial Hospital, Pasadena;
  3. Gynecologic Oncology, Kaiser Permanente, Los Angeles, CA.
  1. Address correspondence and reprint requests to Monica Avila, MD, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Kaiser Permanente, 4900 Sunset Blvd, Los Angeles, CA 90027. E-mail:


Objectives Risk factors and infection rates of radical robotic procedures have yet to be described in gynecology. A practice improvement strategy using a solitary dose of vaginal metronidazole the night before surgery was initiated to determine if it decreased the risk of pelvic infection.

Methods A retrospective chart review of robotic radical hysterectomies for gynecologic malignancy at our institution from April 2010 through April 2016 was performed. Demographic data, operative data, and data on use of metronidazole before surgery were collected. χ2 Statistical analysis, Student t test, and multivariate analysis were performed to analyze the data.

Results Ninety-four patients met the inclusion criteria, and 46 patients received vaginal metronidazole. Demographic and clinical factors were similar between the 2 groups. The pelvic infection rate was significantly higher in nonusers at 13% (6/46) compared with users at 0% (0/42) (P ⩽ 0.05). The genitourinary infection rate was also significantly higher in nonusers at 20% as compared with users at 2.2% (P = 0.02). Operative risk factors found to be associated with pelvic infection included hospital length of stay, blood loss, and metronidazole use. Multivariate regression analysis determined that only vaginal metronidazole had a clinically significant reduction of pelvic and genitourinary infection.

Discussion A single dose of preoperative vaginal metronidazole reduces the risk of pelvic and genitourinary infection after robotic radical hysterectomy.

  • Hysterectomy
  • Infection
  • Metronidazole
  • Radical
  • Robotic

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  • The authors declare no conflicts of interest.