Preoperative Vaginal Preparation and Infection After Gynecologic Surgery

Importance Current literature insufficiently identifies the optimal preoperative vaginal antiseptic to reduce rates of surgical site infection (SSI) after gynecologic surgery. Objective The objective of this study was to determine the rate of chlorhexidine vaginal preparation use in gynecologic surgery with and without postoperative SSI compared with iodine. Study Design We performed a retrospective case-control study of women undergoing any gynecologic surgery between January 2010 and December 2023 at an urban academic medical center. Adult women diagnosed with and treated for a postoperative SSI within 30 days of gynecologic surgery were identified as cases and matched 1:4 to the 2 preceding and 2 subsequent gynecologic surgical procedures performed on the same day without postoperative SSI. Additional SSI risk factors were analyzed as secondary objectives. Standard group comparisons were performed. A multivariable logistic regression was used to assess factors associated with SSI. Results SSI cases (n=101) were matched to controls (n=404). Cases and controls differed on numerous baseline and intraoperative characteristics, including insurance type, American Society of Anesthesiologists physical status, comorbidities, malignancy, surgical route, major/minor surgery, estimated blood loss, intraoperative complications, and operative time. Cases were less likely to undergo chlorhexidine vaginal preparation (11% vs 26%, P <0.01) and more likely to have a non-SSI postoperative complication (32.7% vs 7.0%, P <0.01), readmission (17.0% vs 4.3%, P <0.01), and reoperation (17.2% vs 0%, P <0.01). In a backwards regression, chlorhexidine vaginal preparation was associated with significantly lowered odds (adjusted odds ratio, 0.4, 0.17–0.89) of SSI after gynecologic surgery. Conclusion Patients undergoing chlorhexidine vaginal preparation before gynecologic surgery had a 60% decreased odds of SSI within 30 days of surgery.