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. DESIGN Retrospective cohort study. SETTING All clinics including patients in the Swedish National Register for Gynecological Surgery. POPULATION 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. MAIN OUTCOME MEASURES 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. CONCLUSION 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.