The Role of Intra-Operative Wound Irrigation with Normal Saline in Reduction of Surgical Site Infection in Gynecological Surgeries

Objective: To evaluate the efficacy of intra-operative wound irrigation with normal saline in reducing surgical site infections in gynaecological surgeries. Methods: It is a prospective cohort study carried out at Obstetrics and Gynaecology Department, Pak-Emirates Military Hospital, Rawalpindi from 1st November 2019 to 30th April 2020. A total of 400 patients undergoing abdominal surgery for gynecological reasons were recruited by consecutive non-probability technique. Patients with known comorbidities were excluded. Participants of study were allocated cohort and control groups at the end of the surgery after closing the abdominal fascia. In cohort group, the subcutaneous soft tissue was irrigated with 1000 ml of Normal saline solution before skin closure and sterile dressing. No intra-operative wound irrigation was performed in the control group. The primary and secondary endpoint measures (SSI up to 10th Post-Operative day) and (SSI up to 30th Post-Operative day) respectively, were assessed clinically. Results: The study included 400 patients, with 200 in the cohort group and 200 in the control group with Mean Age of (Mean ± SD) 33.6±8.1 years. Majority of the patients had Pre-Op Hemoglobin of >11 g/dl (216)54%. Most common surgeries were Caesarean section (324)81% and Hysterectomy (40)10%. Maximum surgeries were performed between 30-30 min (312)78% with mean hospital stay of (Mean ± SD) 2.9±0.5 days. Analysis of the results showed that Intra-operative wound irrigation with normal saline significantly lesser rate of postoperative SSIs in comparison to no irrigation at both primary outcome measure that was SSI at 10th Post-operative day (POD)(RR=0.417, 95 % CI [0.15;1.161]) and secondary outcome measure that was SSI at 30th POD(RR=0.286, 95 % CI [0.060;1.359]). Conclusion: Intra-operative wound irrigation with Normal Saline decreases the risk of SSI by 58.3% (AR) at 10thPOD and by 71.4% (AR) at 30th POD in otherwise healthy women with no comorbidities.