17 Postoperative infectious morbidity after hysterectomy: A propensity-matched analysis comparing vaginal preparation with povidone iodine versus chlorhexidine

Abstract

To compare rates of infectious morbidity and hospital utilization with preoperative vaginal preparation using povidone iodine (PI) or chlorhexidine (CHX) prior to hysterectomy. This was a retrospective analysis of women who underwent hysterectomy for gynecologic indications at 70 hospitals in a statewide surgical collaborative between January 2017 and December 2019. The primary outcome was post-operative infectious morbidity which included urinary tract infection and surgical site infection (SSI) involving superficial, deep, or organ space tissues within 30 days of surgery. To adjust for confounding, propensity score matching, 1:1 without replacement and with a caliper of 0.005 was performed to create cohorts that had vaginal preparation with either PI or CHX and did not differ in observable characteristics. We compared rates of infectious morbidity as well as hospital utilization (reoperation, readmission, and ED visits) in the matched cohorts. In the statewide collaborative, there were 18,184 patients who received PI and 3,018 who received CHX. After propensity score matching of 2935 pairs, the PI and CHX groups did not differ in demographics, comorbidities, choice of preoperative antibiotics, benign vs malignant surgical indication, and surgical approach (Table 1). PI was associated with a lower rate of infectious morbidity when compared to the CHX group (3.0% vs 4.3%, P = 0.008; Figure 1). There were significantly lower rates of urinary tract infection (1.1% vs 1.7%, P = 0.034) and emergency department visits (7.9% vs 9.7%, P = 0.013) in the PI group when compared with CHX. There were non-significant trends of lower rates of SSI (2.0% vs 2.7%, P = 0.071) and reoperation (1.6% vs 2.1%, P = 0.174) in the PI group when compared with CHX. This propensity score-matched analysis provides evidence that povidone iodine is preferable to chlorhexidine for vaginal preparation prior to hysterectomy due to lower rates of infectious morbidity and fewer emergency department visits. However, the absolute differences in infectious morbidity rates were relatively small, and in the event of an iodine allergy, chlorhexidine appears to be a reasonable alternative.View Large Image Figure ViewerDownload Hi-res image Download (PPT)