The influence of preoperative vaginal cleansing on postoperative infectious morbidity in abdominal total hysterectomy for benign indications.
OBJECTIVE
To evaluate whether vaginal cleansing reduces the risk of postoperative infection after abdominal total hysterectomy on benign indications and to analyze risk factors.


METHODS
Retrospective cohort study.


METHODS
All clinics including patients in the Swedish National Register for Gynecological Surgery.


METHODS
All 7,193 women who underwent abdominal total hysterectomy for benign indications from 2000 to 2007.


METHODS
Information on clinic routines for preoperative vaginal cleansing was obtained retrospectively in a postal survey. Associations between routines for vaginal cleansing and structured data from the Register were analyzed by means of multivariate logistic regression models. The main effect variable was postoperative infections defined as infections treated with antibiotics within six to eight weeks postoperatively, reported by the patient or the physician.


METHODS
Prevalence and risk factors for postoperative infections.


RESULTS
Prevalence of postoperative infections was 14.4%. The prevalence did not differ between those having had vaginal cleansing using chlorhexidine and those without vaginal cleansing, whereas using saline solution was encumbered with a significantly increased risk. Risk factors for postoperative infections were age >60, obesity, smoking, weight of the uterus, duration of hospital stay, blood transfusion, and peroperative injury of the urinary bladder or ureter.


CONCLUSIONS
Vaginal cleansing using chlorhexidine solution did not reduce the risk of postoperative infections, whereas vaginal cleansing using saline solution seemed to increase the risk. Some risk factors for postoperative infectious morbidity seem to be preventable.
Kjølhede
Preben
P
Department of Clinical and Experimental Medicine, University Hospital, Linkoping, Sweden. Preben.Kjolhede@imk.liu.se
Halili
Shefqet
S
Löfgren
Mats
M
D000328:Adult; D000367:Age Factors; D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D002710:Chlorhexidine / Q000494:pharmacology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods; D017053:Infection Control / Q000379:methods; D007239:Infections / Q000453:epidemiology* / Q000209:etiology; D007902:Length of Stay; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011292:Premedication; D011300:Preoperative Care / Q000379:methods*; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D012965:Sodium Chloride / Q000009:adverse effects / Q000494:pharmacology; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D013548:Sweden / Q000453:epidemiology; D065227:Transfusion Reaction
D000891:Anti-Infective Agents, Local; D012965:Sodium Chloride; D002710:Chlorhexidine