Perioperative antibiotic prophylaxis in elective scrotal surgery: a retrospective cohort analysis of surgical site infections and risk factors.

Purpose To assess the effect of single-dose perioperative antibiotic prophylaxis (PAP) on surgical site infection (SSI) rates and related outcomes in elective scrotal or inguinal testicular surgery. Methods Retrospective cohort study of patients who underwent elective clean scrotal or inguinal testicular surgery. Patients were stratified by PAP administration: single-dose PAP versus no PAP. Outcomes were SSI incidence, overall complications and severity (Clavien-Dindo classification and Comprehensive Complication Index [CCI]), length of stay, and readmission rates. Univariable regression analysis identified SSI risk factors in non-PAP patients. Results Between 09/2018 and 09/2022, 105 (59%) patients received no PAP and 73 (41%) received PAP. The median follow-up of the total cohort was 10.3 months (interquartile range 1.1–21.9). Overall complication rates were similar between non-PAP and PAP groups (28% vs. 22%, p = 0.4) as were SSI (12% vs. 4%, p = 0.058), representing a threefold difference, though not statistically significant. Similarly, no significant differences could be shown in unplanned hospital visits (26% vs. 16%, p = 0.13), median CCI (26.2 vs. 26.2, p = 0.7), or specific complications including scrotal hematoma (10% vs. 6%, p = 0.2), swelling (2% vs. 4%, p = 0.4), prolonged pain (2% vs. 4%, p = 0.4), and wound dehiscence (3% vs. 2%, p = 0.6). In the non-PAP group, prolonged surgery duration (per minute increase; OR 1.04, 95% CI 1.01–1.07, p = 0.013) and postoperative scrotal hematoma (OR 5.4, 95% CI 1.23–21.86, p = 0.019) were independent risk factors for SSI development. Conclusion Although no statistically significant benefit of PAP was observed, the threefold lower rate of SSI in patients receiving PAP may indicate a potential effect and highlights the need for randomized trials with larger patient cohorts.