Abstract
-
Purpose
- Minimally invasive techniques are increasingly applied in the management of pilonidal disease. While laser therapy is well established, radiofrequency (RF) represents a newer alternative with theoretical advantages. However, no prospective data have yet been published on its use. This study aimed to assess the safety, efficacy, and patient satisfaction associated with RF treatment for infected pilonidal sinus.
-
Methods
- We conducted a prospective, single-center pilot study including consecutive patients treated with RF between March and December 2023. The procedure was performed under spinal or general anesthesia in an outpatient setting using a radial RF probe (25 W, 4 MHz) following mechanical debridement. Patients were followed up at 15 days and at 1, 3, and 6 months. The primary endpoint was safety; secondary endpoints included healing rate, predictors of failure, postoperative pain, return to activities, and patient satisfaction.
-
Results
- Forty-four patients were enrolled (median age, 25.5 years; 31 men, 70.5%), of whom 38.6% had undergone previous surgery. The median operative time was 12 minutes. No major complications occurred, and minor early events were reported in 6.8% of cases. Complete healing at 6 months was achieved in 77.3% of patients. Failure and recurrence rates were 13.6% and 9.1%, respectively. A history of prior surgery significantly increased the risk of failure (odds ratio, 0.2; P=0.005). The median peak pain score was 2 out of 10, with a median duration of 2 days. Overall, 33 patients (75.0%) were very satisfied, and 40 (90.9%) stated they would undergo the procedure again or recommend it to others.
-
Conclusion
- RF appears to be a safe, minimally invasive outpatient treatment option for pilonidal disease, demonstrating promising efficacy, minimal postoperative pain, and high patient satisfaction.
-
Trial registration
- ClinicalTrials.gov identifier: NCT05855733.
-
Keywords: Pilonidal sinus; Radiofrequency therapy; Minimally invasive surgical procedures; Outpatient surgery; Prospective studies
Graphical abstract
INTRODUCTION
Pilonidal sinus disease is a common and debilitating condition with a reported incidence of 48 cases per 100,000 individuals, and its prevalence continues to rise [1]. Although surgical treatment is necessary, no consensus exists regarding the optimal approach [2, 3]. Excision with healing by secondary intention, which involves leaving the wound open to heal by granulation, remains the most commonly used technique in France due to its low recurrence rate, estimated at below 5%. However, this method requires daily local wound care, a prolonged healing period, and often an extended absence from work [4].
To address these limitations, some teams have adopted midline closures (for smaller wounds), paramedian closures based on the Karydakis or Bascom techniques, or more complex flap procedures. Despite their potential advantages, these techniques are technically demanding and carry a higher risk of postoperative complications, such as necrosis, wound dehiscence, and infection, as well as recurrence compared with classical excision [4].
In line with efforts to improve postoperative outcomes, minimally invasive or “conservative” techniques have recently gained attention in response to growing patient demand for simpler recovery courses [5]. Among these, laser treatment, widely used in our department [6, 7], has shown advantages such as minimal or no postoperative pain, early resumption of daily activities, and high patient satisfaction. Nevertheless, its failure and recurrence rates remain higher than those of conventional excision, reaching approximately 30% [8].
More recently, radiofrequency (RF) has emerged as a novel therapeutic option in proctologic surgery, notably for hemorrhoidal disease (Rafaelo procedure) [9] and anal fistulas (Fistura procedure) [10, 11]. RF operates through thermocoagulation generated by very-high-frequency electromagnetic waves (4 MHz). To our knowledge, no published study has yet described RF for the treatment of infected pilonidal sinus. However, the fibers used for anal fistulas appear well suited to this pathology. RF offers various fiber diameters, facilitating adaptation to the morphology of sinus tracts. In particular, large-caliber fibers (9 Fr) seem well suited to the wide and deep cavities of pilonidal sinuses, potentially allowing more complete destruction of granulation tissue and improved wall retraction. Furthermore, RF is simple to operate, requiring only a single power setting at 25 W. Previous studies in proctology have demonstrated a favorable safety profile, likely related to its limited tissue penetration depth of approximately 3 mm [9–11].
The aim of this study was to evaluate RF as a minimally invasive treatment for pilonidal sinus disease.
METHODS
Ethics statement
This study was approved by the Institutional Ethics Committee of Groupe Hospitalier Paris Saint-Joseph (No. 22.12.04). All participants received detailed written information and provided signed informed consent prior to enrollment. The trial was registered on ClinicalTrials.gov (identifier: NCT05855733).
Study design
We conducted a prospective, interventional, single-center, open-label pilot study involving patients with infected pilonidal sinus who were treated in the proctology department of Groupe Hospitalier Paris Saint-Joseph between March 7, 2023, and December 11, 2023.
Patients
The RF technique was offered to patients deemed suitable for a minimally invasive approach to pilonidal sinus management. All patients who agreed to undergo the procedure were consecutively enrolled during the study period. Inclusion was confirmed only after verifying all eligibility criteria, providing full oral and written information, and obtaining signed informed consent.
Eligible participants were adults aged 18 years or older who presented with an infected pilonidal sinus, excluding those in the acute abscess phase requiring emergency drainage. Women of childbearing potential were required to use effective contraception, defined as a method with less than 1% annual failure rate under proper use. Additional inclusion criteria included affiliation with a national health insurance system, fluency in French, and provision of written informed consent.
Patients were excluded if they presented with a pilonidal sinus in the acute abscess stage, participated concurrently in another interventional clinical trial involving human subjects, or had known cardiac disease, including pacemaker implantation. Other exclusion criteria comprised contraindication to local or general anesthesia, associated anal pathologies such as fissure, infection, or Longo sequelae, and the use of anticoagulant or antiplatelet therapy other than aspirin. Patients with congenital bleeding or coagulation disorders, contraindication to magnetic resonance imaging, pregnancy, or breastfeeding were also excluded. Additional exclusion criteria included legal protection measures such as guardianship, trusteeship, or court-appointed safeguard, and refusal to participate in follow-up.
Surgical technique
The procedure was performed under general or spinal anesthesia with the patient in the prone position (Fig. 1). Two hours before surgery, patients received preoperative medication consisting of metronidazole and paracetamol. Immediately before the procedure, the operative site was shaved using clippers. The pilonidal pits were excised with a 3-mm skin biopsy punch, and any secondary openings were treated using electrocautery. The pilonidal cavity was then mechanically curetted and extensively irrigated with normal saline to remove hair, debris, and granulation tissue. Povidone-iodine (Betadine) was avoided because of the risk of pooling in the cavity and the theoretical possibility of overheating-related burns during RF application, as noted in the manufacturer’s instructions for the probe.
Following preparation, an RF probe with a diameter of 7 or 9 Fr was introduced into the cavity through the most proximal orifice. The probe, connected to the electrosurgical RF generator set to 25 W and 4 MHz, was advanced to the most distal orifice and then slowly withdrawn at approximately 5 mm per 12 seconds while applying external compression to the skin to maintain contact between the probe and the cavity wall, thereby promoting tissue collapse. If secondary tracts were present, the same procedure was repeated through each corresponding secondary opening.
In cases of large or complex cavities, an additional round of curettage and RF treatment could be performed if there was any uncertainty regarding the completeness of the initial ablation. However, multiple passes over the same area were generally discouraged; instead, the operator was advised to take sufficient time to ensure complete treatment in a single pass. No histological or microbiological samples were obtained during the procedure.
Postoperative management
Antibiotic therapy was prescribed for 7 days after surgery. Patients were instructed to wash the operative area twice daily with mild soap and to apply an absorbent dressing in case of discharge, continuing this regimen until the first follow-up visit or longer if clinically indicated. The need for postoperative nursing care was left to the discretion of the operating surgeon. All patients received instructions for hair removal, and intense physical activity was discouraged for the first 15 postoperative days. Follow-up visits were scheduled at 1, 3, and 6 months after the procedure.
Objectives
The primary objective was to assess the safety of the RF procedure, defined as the incidence of early complications occurring within 15 days postoperatively. Complications were classified according to the Clavien-Dindo classification [12]. In this framework, minor complications correspond to grades I and II, representing any deviation from the normal postoperative course that does not require specific treatment or that necessitates only pharmacologic management. Major complications correspond to grades III, IV, and V, which include events requiring surgical, endoscopic, or radiologic intervention, intensive care management, or resulting in death.
Secondary objectives included the evaluation of treatment efficacy, identification of predictors of treatment failure, assessment of postoperative pain using a visual analog scale (0–10), measurement of the time to return to normal activities (in days), and assessment of overall patient satisfaction at 6 months.
Endpoints
Data collected included demographic and clinical characteristics, procedure duration, postoperative complications (such as bleeding, urinary disturbances, or fever), treatment efficacy, postoperative pain, duration of work absence, time to return to normal daily activities, and patient satisfaction.
Treatment efficacy at 6 months was defined by complete closure of all tracts with the absence of pain, discharge, or swelling. Recurrence was defined as the reappearance of symptoms after an initial healing phase, whereas treatment failure referred to persistent non-closure of tracts and/or ongoing pain, discharge, or swelling.
Postoperative pain was self-evaluated using a visual analog scale and by documenting analgesic use for up to 14 days after the procedure. Return to normal daily activities was defined as the ability to resume routine self-care and household activities, excluding professional work. Patient satisfaction at 6 months was assessed using a 5-point scale (very dissatisfied, somewhat satisfied, neutral, moderately satisfied, or very satisfied) and further evaluated based on the patient’s willingness to recommend the procedure to others or to undergo it again if necessary.
Statistical analysis
Continuous variables were expressed as mean±standard deviation or medians with interquartile ranges (IQRs), while categorical variables were summarized as counts and percentages. Outcomes related to the primary and secondary objectives were described as odds ratios (ORs) with 95% confidence intervals (CIs), calculated using the Clopper-Pearson method.
Potential factors associated with treatment efficacy at 6 months were explored using univariable logistic regression analyses. Variables with a P-value of <0.20 in univariable testing, as well as clinically relevant factors identified in previous studies (age, sex, and prior pilonidal surgery), were included in the multivariable logistic regression model to identify independent predictors of success. To prevent overfitting given the limited number of events, the model was restricted to a maximum of 4 variables, which included history of previous surgery, operative time, prolonged sitting position, and postoperative antibiotic use. Receiver operating characteristic curves were used to estimate the area under the curve (AUC) for operative time as a predictor of treatment efficacy at 6 months, and the Youden method was applied to determine the optimal cutoff value.
RESULTS
Patients
During the study period, 579 patients were evaluated for infected pilonidal sinus in our department. Among them, 66 underwent excision with healing by secondary intention, while 226 patients (39.0%) expressed a preference for a minimally invasive technique. RF treatment was offered to these patients, and 50 (8.6%) accepted the new procedure (Fig. 2). Of these 50 patients, 44 (7.6%) ultimately underwent RF surgery and were included in the analysis. Among the 6 patients who were not analyzed, 4 changed their minds and declined surgery, and 2 opted for laser treatment instead of RF.
Demographic characteristics
Patient demographics and clinical characteristics are summarized in Table 1. Two patients had ulcerative colitis and were receiving biologic therapy, and one patient was living with HIV under antiretroviral treatment. No cases of diabetes mellitus were recorded. Thirteen patients (29.5%) reported a family history of infected pilonidal sinus. Among the 17 patients (38.6%) with a prior surgical history, 9 had undergone laser treatment and 8 had been treated with open excision followed by secondary healing.
Operative data
The median interval between the inclusion consultation and surgery was 3.5 months (IQR, 2.0–7.8 months). All patients underwent outpatient treatment, with spinal anesthesia used in 39 cases (88.6%). All patients presented visible pilonidal pits: a single pit in 14 patients, 2 pits in 16 patients, and 3 or more in the remainder. In addition to the pits, 28 patients (63.6%) had paramedian external fistulous openings: 1 opening in 24 patients (54.5%) and 2 or more in the others.
A 9-Fr probe was used in 39 patients, and a 7-Fr probe in the remainder. The median energy delivered was 1,500 J (IQR, 1,100–1,800 J). Thirteen surgeons performed the procedures, and none reported technical difficulty. The mean operative duration was 13.1±4.9 minutes, and the median was 12 minutes (IQR, 10–16 minutes).
Postoperative data
Antibiotic therapy was prescribed for 41 patients (93.2%) and withheld in 3 cases due to allergy or intolerance. The antibiotics used were amoxicillin/clavulanic acid in 32 patients (72.7%), pristinamycin in 7, and metronidazole in 2. Postoperative nursing care was prescribed for 6 patients, with a median duration of 8.5 days (IQR, 7.0–13.8), consisting of wound lavage and packing.
Twenty patients adhered to hair removal recommendations during the first postoperative month: 1 with laser, 1 with waxing, 1 with depilatory cream, and 17 with shaving. At the 6-month follow-up, 8 patients continued hair removal: 2 with laser, 2 with waxing, 3 with depilatory cream, and 1 with shaving.
Safety
During the postoperative period, complications occurred in 3 patients (6.8%): 1 case of bleeding that did not require reoperation, 1 abscess on postoperative day 14, and 1 urinary tract infection.
Efficacy and predictors of treatment failure
All 44 patients completed the 6-month follow-up. Complete healing was achieved in 34 patients (77.3%). Four patients (9.1%) experienced recurrence between 3 and 6 months: 2 presented with abscesses and 2 with reopening of sinus tracts. Six patients (13.6%) experienced treatment failure: 4 had persistent pain and discharge, and 2 developed abscesses before the 3-month follow-up (Fig. 3). Among those with failure or recurrence, 6 patients underwent reoperation: 4 were treated by open excision and 2 by laser therapy.
Univariable analysis considered patient and sinus characteristics, family and surgical history, anesthesia type, probe size, energy delivered, postoperative antibiotic use, nursing care, and hair removal practices. The results are presented in Table 2.
Multivariable analysis revealed that a history of previous surgery significantly reduced the likelihood of treatment success by approximately fivefold (OR, 0.2; 95% CI, 0.1–1.0; P=0.005). Conversely, longer operative duration tended to increase the probability of success (OR, 1.2; 95% CI, 0.9–1.5; P=0.064). The optimal operative time threshold was 11.5 minutes (AUC, 0.729; sensitivity, 0.6; specificity, 0.8) (Fig. 4).
Postoperative pain
Pain was assessed daily for 14 days following surgery (Fig. 5). The median peak pain score on the visual analog scale was 2 (IQR, 0–4) out of 10, with a median duration of 2 days (IQR, 0–5 days). Twenty-one patients (47.7%) used analgesics: 8 (38.1%) used step 1 medications and 13 (61.9%) used step 2 medications. No patient required step 3 analgesics.
Return to activity
The median time to resume normal daily activities was 2.0 days (IQR, 1.0–4.0 days), and the median duration of work absence was 3.0 days (IQR, 1.8–4.0 days).
Overall satisfaction
As shown in Fig. 6, 33 patients (75.0%) reported being very satisfied with the procedure. In addition, 37 patients (84.1%) stated that they would recommend the treatment to relatives, and 40 (90.9%) indicated that they would undergo the procedure again if necessary.
DISCUSSION
This pilot study is the first to evaluate the use of RF in the treatment of infected pilonidal sinus. The results demonstrate an acceptable safety profile, promising clinical efficacy, and high overall patient satisfaction.
The median age of the study population was 25.5 years (IQR, 22.0–30.6 years), with a male predominance (70.5%). A family history of pilonidal sinus was found in 29.5% of cases, consistent with the classical demographic pattern of this condition [8].
The safety of RF in this indication appears satisfactory, with an early postoperative complication rate below 7% and no cases requiring surgical revision. This rate is comparable to, or even lower than, that reported in laser therapy series, where minor complications range from 5% to 15% [13–17].
The 6-month healing rate (77.3%) falls within the range reported for minimally invasive techniques, particularly laser treatment, which shows success rates between 60% and 85% depending on the series [8, 13, 18, 19]. The recurrence rate (9.1%) is likewise consistent with published data.
Unlike our previous retrospective study on laser therapy for infected pilonidal sinus [6], this analysis did not show a significant negative influence of overweight or the presence of external fistulous openings on the efficacy of RF. Notably, 20 patients (45.5%) in this study had at least 2 external fistulous openings. In contrast, a history of multiple previous operations is well recognized as a predictor of treatment failure or recurrence [20], and this association was confirmed here, with prior surgery increasing the risk of RF failure fivefold. The direct correlation observed between operative duration and the success rate may initially appear paradoxical. However, it is plausible that longer procedures reflect more meticulous and comprehensive curettage, irrigation, and cavity treatment, thereby improving outcomes.
Another major strength of RF is the minimal postoperative pain reported by patients. The median peak pain score was low (2 out of 10), and the median pain duration was short (2 days). Fewer than half of the patients required analgesics, and only step 1 or 2 medications were used. The median duration of work absence and interruption of daily activities was also brief (≤3 days). This comfort profile is clearly superior to that of excisional surgical techniques and comparable to that observed with laser treatment [13, 19]. These findings emphasize the suitability of RF for young, active patients who seek to minimize the impact of treatment on quality of life.
The RF procedure also appears technically straightforward and reproducible, with a short median operative time (12 minutes), a significant advantage for its implementation in outpatient settings. Overall satisfaction was high: three-quarters of patients reported being very satisfied with the treatment, and more than 90% stated they would recommend it to others or undergo it again if necessary. These results are at least equivalent to those reported for laser therapy [6]. This high satisfaction level aligns with the favorable safety profile, simple postoperative recovery, and good cosmetic outcomes—factors that are particularly relevant in a young population often concerned with physical appearance. Indeed, cosmetic outcomes after excisional techniques, especially those involving flap procedures or closures, are not always acceptable [21].
This study has several limitations. The study was conducted at a single center, involved a relatively small sample size, had a limited 6-month follow-up period, and lacked a comparative control group. Nonetheless, this investigation constitutes the first prospective evaluation of RF for this indication. It establishes the feasibility and safety of the technique and supports its potential integration into routine clinical practice. These preliminary results provide a foundation for larger, comparative studies.
Conclusions
RF appears to be a promising minimally invasive treatment for infected pilonidal sinus. It can be safely performed on an outpatient basis, demonstrates an acceptable safety profile, results in minimal postoperative pain, and achieves satisfactory short-term success rates. These preliminary data justify further large-scale comparative studies to define its precise role among standard treatments. RF may also represent a valuable therapeutic alternative for patients with prior surgical interventions, who are generally at higher risk of recurrence.
ARTICLE INFORMATION
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Conflict of interest
Nadia Fathallah and Vincent de Parades have received research grants from Abbvie, Amgen, Tillots, Sandoz, Takeda, Legrand, Biolitec, Celltrion, F Care Systems, Norgine, and THD. They also served as consultants for Takeda and received consulting fees from Abbvie, Tillots, and Takeda. Amine Antonin Alam served as a consultant for Biolitec and F Care Systems and received consulting fees from Biolitec. No other potential conflict of interest relevant to this article was reported.
-
Funding
This study was supported by an unrestricted grant from F Care Systems, which covered the cost of the radiofrequency probes, patient follow-up, and statistical analysis. The sponsor had no role in the design, execution, analysis, or interpretation of the study.
-
Acknowledgments
The authors would like to thank the Clinical Research Center of Groupe Hospitalier Paris Saint-Joseph for their assistance in conducting the study, and F Care Systems for their financial support in providing the radiofrequency probes and enabling appropriate patient follow-up.
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Author contributions
Conceptualization: NF; Data curation: NF; Formal analysis: NF; Funding acquisition: NF; Investigation: all authors; Project administration: NF; Supervision: NF; Validation: NF, VdP; Writing–original draft: NF; Writing–review & editing: all authors. All authors read and approved the final manuscript.
Fig. 1.Technical procedure. (A) Preset configuration of the generator. (B) Creation of openings at the level of the median pits using a punch biopsy tool, allowing for cleaning and mechanical curettage of the cavity. (C) Insertion of a 9-Fr radiofrequency probe into the pilonidal cavity. (D) Gradual withdrawal of the probe at a rate of 5 mm per 12 seconds while delivering radiofrequency energy, with simultaneous external pressure on the skin to ensure proper tissue coaptation and blood aspiration.
Fig. 2.Flowchart.
Fig. 3.Efficacy of radiofrequency treatment for infected pilonidal sinus.
Fig. 4.Receiver operating characteristic curve estimating the area under the curve (AUC) of operative time for efficacy at 6 months.
Fig. 5.Progression of pain using the visual analog scale (VAS) during the first 14 postoperative days. The blue line represents the mean VAS score, and the shaded area indicates the 95% confidence interval.
Fig. 6.Patient satisfaction with the radiofrequency procedure.
Table 1.Demographic characteristics of the study population (n=44)
|
Characteristic |
Value |
|
Age (yr) |
25.5 (22.1–30.6) |
|
Sex |
|
|
Male |
31 (70.5) |
|
Female |
13 (29.5) |
|
Body mass index (kg/m2) |
24.3 (22.5–27.2) |
|
Active smoker |
14 (31.8) |
|
Regular physical activity |
20 (45.5) |
|
High-risk alcohol intake (≥3 drinks/day) |
1 (2.3) |
|
Prolonged sitting position |
31 (70.5) |
|
Family history of pilonidal disease requiring surgery |
13 (29.5) |
|
Symptom duration (yr) |
2 (1–4) |
|
History of pilonidal sinus surgery |
17 (38.6) |
|
Associated hidradenitis suppurativa |
2 (4.5) |
Table 2.Univariable analysis of factors associated with treatment efficacy
|
Variable |
OR (95% CI) |
P-value |
|
Age (yr) |
1.01 (0.92–1.10) |
0.86 |
|
Sex |
|
0.41 |
|
Female |
1 (Reference) |
|
|
Male |
1.85 (0.42–8.11) |
|
|
Body mass index (kg/m2) |
0.99 (0.85–1.15) |
0.88 |
|
Smoking status |
|
0.62 |
|
Active smoker |
1 (Reference) |
|
|
Other |
0.50 (0.03–7.54) |
|
|
Regular physical activity |
|
0.24 |
|
No |
1 (Reference) |
|
|
Yes |
2.48 (0.54–11.28) |
|
|
High-risk alcohol intake |
|
0.99 |
|
No |
1 (Reference) |
|
|
Yes |
0.00 (0.00–>100) |
|
|
Prolonged sitting position |
|
0.09 |
|
No |
1 (Reference) |
|
|
Yes |
3.71 (0.83–16.55) |
|
|
Symptom duration (yr) |
0.83 (0.68–1.03) |
0.09 |
|
Inflammatory bowel disease |
|
0.38 |
|
No |
1 (Reference) |
|
|
Yes |
0.27 (0.02–4.80) |
|
|
Immunomodulator or immunosuppressive treatment |
|
0.38 |
|
No |
1 (Reference) |
|
|
Yes |
0.27 (0.02–4.80) |
|
|
No. of previous operations |
|
0.31 |
|
1 |
1 (Reference) |
|
|
>1 |
0.25 (0.02–3.66) |
|
|
History of pilonidal sinus surgery |
|
0.41 |
|
No |
1 (Reference) |
|
|
Yes |
0.54 (0.12–2.36) |
|
|
Abscess drainage |
|
0.20 |
|
No |
1 (Reference) |
|
|
Yes |
0.25 (0.03–2.06) |
|
|
Open excision with secondary intention healing |
|
0.20 |
|
No |
1 (Reference) |
|
|
Yes |
0.25 (0.03–2.06) |
|
|
Excision with primary closure |
|
0.38 |
|
No |
1 (Reference) |
|
|
Yes |
0.27 (0.02–4.80) |
|
|
Laser treatment |
|
0.97 |
|
No |
1 (Reference) |
|
|
Yes |
1.04 (0.18–6.02) |
|
|
Type of anesthesia |
|
0.88 |
|
General |
1 (Reference) |
|
|
Other |
0.27 (0.02–4.80) |
|
|
No. of secondary openings |
|
0.88 |
|
0–1 |
1 (Reference) |
|
|
>1 |
1.20 (0.12–12.14) |
|
|
No. of visible pits |
|
0.41 |
|
≤2 |
1 (Reference) |
|
|
>2 |
0.54 (0.12–2.36) |
|
|
Probe size (Fr) |
|
0.21 |
|
7 |
1 (Reference) |
|
|
9 |
3.87 (0.47–31.91) |
|
|
Total energy delivered (J) |
0.86 (0.27–2.77) |
0.80 |
|
Operative time (min) |
1.22 (0.99–1.51) |
0.06 |
|
Duration of sick leave (day) |
1.31 (0.92–1.87) |
0.13 |
|
Nursing care |
|
0.71 |
|
No |
1 (Reference) |
|
|
Yes |
1.55 (0.16–15.07) |
|
|
Depilation |
|
0.69 |
|
No |
1 (Reference) |
|
|
Yes |
1.33 (0.32–5.59) |
|
|
Postoperative antibiotics |
|
0.11 |
|
No |
1 (Reference) |
|
|
Yes |
8.25 (0.66–>100) |
|
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