Background

Antiseptic vaginal preparation is recommended before gynecologic surgery; however, there is a lack of data regarding the effectiveness of different agents.

Objective

To compare rates of postoperative infectious complications and hospital utilization with preoperative vaginal preparation using povidone-iodine or chlorhexidine before hysterectomy.

Study Design

This was a retrospective analysis of patients who underwent hysterectomy for gynecologic indications at 70 hospitals in a statewide surgical collaborative between January 2017 and December 2019. The primary outcome was postoperative infectious complications (including urinary tract infection, surgical site infections involving superficial, deep, or organ space tissues, or cellulitis) within 30 days of surgery. To adjust for confounding, propensity score matching, 1:1 without replacement and with a caliper of.005 was performed to create cohorts that had vaginal preparation with either povidone-iodine or chlorhexidine and did not differ in observable characteristics. We compared the rates of infectious morbidity and hospital utilization (emergency department visits, readmission, reoperation) in the matched cohorts.

Results

In the statewide collaborative, there were 18,184 patients who received povidone-iodine and 3018 who received chlorhexidine. After propensity score matching of 2935 pairs, the povidone-iodine and chlorhexidine groups did not differ in demographics, comorbidities, choice of preoperative antibiotics, benign vs malignant surgical indication, and surgical approach. Povidone-iodine was associated with a lower rate of infectious morbidity (3.0% vs 4.3%; P=.01), urinary tract infection (1.1% vs 1.7%; P=.03) and emergency department visits (7.9% vs 9.7%; P=.01) than with chlorhexidine. There were nonsignificant trends of lower rates of surgical site infection (2.0% vs 2.7%; P=.07) and reoperation (1.6% vs 2.1%; P=.18).

Conclusion

This propensity score matched analysis provides evidence that povidone-iodine is preferable to chlorhexidine for vaginal preparation before hysterectomy because of lower rates of infectious morbidity and fewer emergency department visits. However, the absolute differences in infectious morbidity rates were approximately 1%, and in the event of an iodine allergy, chlorhexidine appears to be a reasonable alternative.

中文翻译：

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子宫切除术前使用聚维酮碘或氯己定进行阴道准备：倾向评分匹配分析

背景

建议在妇科手术前做好阴道消毒剂；然而，缺乏关于不同药剂有效性的数据。

客观的

比较子宫切除术前使用聚维酮碘或氯己定进行术前阴道准备的术后感染并发症发生率和医院利用率。

学习规划

这是一项对 2017 年 1 月至 2019 年 12 月在全州外科合作中因妇科适应症接受子宫切除术的患者的回顾性分析。器官间隙组织或蜂窝织炎）在手术后 30 天内。为了调整混杂因素，倾向评分匹配，1:1 无替换和 0.005 的卡尺被执行以创建具有聚维酮碘或氯己定阴道准备并且在可观察特征上没有差异的队列。我们比较了匹配队列中的传染病发病率和医院利用率（急诊就诊、再入院、再手术）。

结果

在全州合作中，有 18,184 名患者接受了聚维酮碘治疗，3018 名患者接受了氯己定治疗。在对 2935 对进行倾向评分匹配后，聚维酮碘组和氯己定组在人口统计学、合并症、术前抗生素选择、良性与恶性手术指征和手术方法方面没有差异。聚维酮碘与较低的感染发病率（3.​​0% 对 4.3%；P =.01）、尿路感染（1.1% 对 1.7%；P =.03）和急诊就诊率（7.9% 对 9.7%）相关; P =.01) 而不是使用氯己定。手术部位感染率（2.0% 对 2.7%；P = .07）和再手术率（1.6% 对 2.1%；P=.18）。

结论

这种倾向评分匹配分析提供的证据表明聚维酮碘比氯己定更适合用于子宫切除术前的阴道准备，因为感染发病率较低，急诊就诊次数较少。然而，感染发病率的绝对差异约为 1%，在碘过敏的情况下，氯己定似乎是一个合理的替代品。