title: Vaginal cleansing and postoperative infectious morbidity in vaginal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery.
abstract: OBJECTIVE
  To evaluate whether preoperative vaginal preparation routines influence postoperative infectious morbidity in vaginal hysterectomy and to analyze risk factors for postoperative infectious morbidity.
  
  
  METHODS
  Retrospective, longitudinal cohort study.
  
  
  METHODS
  Forty -three hospitals in Sweden, participating in the Swedish National Register for Gynecological Surgery.
  
  
  METHODS
  All 6,496 women who were enrolled in the Register and underwent vaginal or laparoscopically assisted vaginal hysterectomy between 1 January 2000 and 1 February 2008.
  
  
  METHODS
  Register data were collected prospectively using doctors' forms and patient questionnaires. Information about vaginal preparation routines in the clinics were achieved retrospectively by an e-mail survey. Multiple logistic regression analyses models were used to determine associations and risk factors.
  
  
  METHODS
  Infectious morbidity within 6-8 weeks postoperatively.
  
  
  RESULTS
  No significant differences were seen in postoperative infectious morbidity in long term between vaginal preparation using saline or chlorhexidine solution or no cleansing. At discharge from hospital, those who had had vaginal cleansing using saline solution had a significantly higher risk of postoperative infections. Risk factors for infectious morbidity were young age, obesity, peroperative injury of the urinary bladder, operative time and duration of hospital stay. Protective were prophylactic antibiotics and concomitant prolapse surgery.
  
  
  CONCLUSIONS
  Saline solution should not be used for vaginal cleansing due to a higher risk of infectious morbidity in the immediate postoperative period. Infectious morbidity may be reduced further by employing preventive measures such as meticulous surgical technique, preoperative weight reduction in obese women and minimizing time in hospital.
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Women and Child Health, Obstetrics and Gynecology, Faculty of Health Sciences, University Hospital, Linköping, Sweden. Preben.Kjolhede@lio.se
authors.forename: Preben
authors.initials: P
authors.lastname: Kjølhede
authors.forename: Shefqet
authors.initials: S
authors.lastname: Halili
authors.forename: Mats
authors.initials: M
authors.lastname: Löfgren
mesh_terms: D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects*; D010535:Laparoscopy; D008875:Middle Aged; D011300:Preoperative Care; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012965:Sodium Chloride / Q000627:therapeutic use*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D013548:Sweden / Q000453:epidemiology
chemical_list: D000891:Anti-Infective Agents, Local; D012965:Sodium Chloride; D002710:Chlorhexidine