INFECTIONS AFTER HYSTERECTOMY - A PROSPECTIVE NATIONWIDE SWEDISH STUDY

Background. An increased use of prophylactic antibiotics to avoid post operative infections in women undergoing hysterectomy has been observe d in Sweden. This investigation was performed a) to study the infectio n rate to enable future evaluation of the effect of prophylactic antib iotic regimens and b) to identify subgroups suitable for intervention. Method. A prospective study comprising all women undergoing pelvic su rgery with hysterectomy during a two month period at forty-two Departm ents of Obstetrics and Gynecology in Sweden. Relevant information rega rding the surgical procedure and the postoperative course was included in a standardized form at discharge from hospital and at a follow-up visit 4 to 6 weeks after surgery. Results. Of the 1060 women included in the study, 23% developed postoperative infections; 9.4% had wound-, cuff-, and/or deep infections, 13% urinary tract infections, and 4% o ther infections unrelated to the surgical site. Only half of the wound /cuff-/deep infections were diagnosed before discharge from the hospit al. Wertheim-Meigs procedures, bleedings peroperatively exceeding 1000 ml, and presence of bacterial vaginosis (BV) were associated with an increased risk of postoperative infections. Among women undergoing abd ominal hysterectomy for benign reasons, (n=159), wound-cuff/deep infec tion was significantly associated with preoperative BV, i.e. 7 of 28 ( 25%) vs. 11 of 131 (8%), respectively (relative risk=3.0, p=0.01). Inf ection was associated with prolonged postoperative hospital stay. Anti biotics were given pre- or postoperatively to 236 (22%) of the 1060 wo men. Reduction in the postoperative infection rate was seen among wome n undergoing vaginal hysterectomy who were given pre- or postoperative antibiotics. Conclusion. The postoperative infection rate after hyste rectomy was clinically significant in this population. Wertheim-Meigs procedures, peroperative bleeding >1000 ml and BV were identified as r isk factors for postoperative infections after hysterectomy.