Key result
Perioperative bundle linked to ~45% less wound gaping vs conventional care after abdominal hysterectomy.
Why the study?
Surgical site infections are a leading cause of unplanned hospital readmissions and morbidity after hysterectomy, motivating investigation into whether a perioperative bundle reduces their incidence.
Does a bundle of perioperative measures reduce surgical site wound infection in women undergoing abdominal hysterectomy?
Cohort (n=200)
No
Does a bundle of perioperative measures reduce surgical site wound infection in women undergoing abdominal hysterectomy?
Absolute Event Rate: 6% vs 11%
p-value: p=0.048
A perioperative care bundle significantly reduces surgical site infections, fever, and hospital stay duration in women undergoing abdominal hysterectomy.
Perioperative bundle was associated with fewer wound complications after abdominal hysterectomy; leaves open need for randomized confirmation before practice change.
Background: Surgical site infections (SSIs) are the second most common reason for unplanned hospital readmissions after hysterectomy and result in increased morbidity and health care costs. The estimated rate of SSI after hysterectomy varies between 1% and 4%. The objective of the study is to investigate if a bundle of perioperative measures (as stated earlier) reduces down the incidence of post-operative surgical site wound infection after abdominal hysterectomy. Materials and Methods: The present prospective study was carried out on total 200 women who were undergo hysterectomy in the operation theater of Department of Obstetrics and Gynecology of IPGMER and SSKM Hospital due to gynecological conditions requiring hysterectomy. Four perioperative bundles of measures are considered – 1. chlorhexidine gluconate and Cetrimide solution (Savlon) wash of the operative field 1 h before the operation, 2. administration of single dose antibiotic (Inj. Ceftriaxone 1 g intravenous) 1 h or less before the incision, 3. vaginal wash with povidone-iodine, and 4. sterile dressing is to be maintained and removed postoperatively after 48 h. Result: We found that in case, 94 (94.0%) patients had Ceftriaxone and 6 (6.0%) patients had clindamycin and gentamicin. In control, 96 (96.0%) patients had ceftriaxone and 4 (4.0%) patients had clindamycin and gentamicin. Association of choice of antibiotic versus group was not statistically significant (P = 0.5164). In case, 6 (6.0%) patients had wound gaping. In control, 11 (11.0%) patients had wound gaping. Association of wound gaping versus group was statistically significant (P = 0.048). Conclusion: The present study found that hospital stay was more in control compared to case which was statistically significant. Fever was more in control compared to case which was statistically significant. In this study, local wound discharge was more in control compared to case which was statistically significant. It was found that wound gaping was more in control compared to case which was statistically significant.
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Biswas et al. (2022) conducted a cohort in Gynecological conditions requiring abdominal hysterectomy (n=200). Perioperative bundle of measures (chlorhexidine wash, single dose antibiotic, vaginal povidone-iodine wash, sterile dressing for 48h) vs. Conventional perioperative measures was evaluated on Wound gaping (p=0.048). A perioperative bundle of measures significantly reduced the incidence of wound gaping (6.0% vs 11.0%, p=0.048) and local wound discharge (9.0% vs 21.0%, p=0.0174) compared to conventional care in women undergoing abdominal hysterectomy.
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