GYNECOLOGIC ONCOLOGY 11, 207--212 (1981) Perioperative Influences on Infectious Morbidity in Radical Hysterectomy' WILLIAM J. MANN, JR., M.D., JAMES W. ORR, JR., M.D., HUGH M. SHINGLETON, M.D.,2 j. MAX AUSTIN, JR., M.D., KENNETH D. HATCH, M.D., PEYTON T. TAYLOR, M.D., EDWARD PARTRIDGE, M.D., AND SENG-JAW SOONG, PH.D. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, and Department of Biostatistics, University of Albama Medical Center, Birmingham, Alabama 35294 Received April 29, 1980 A series of 207 patients, who underwent radical hysterectomy with bilateral pelvic lym- phadenectomy, is presented. Hospital charts were reviewed to determine perioperative influences on operative and postoperative morbidity. Performance of incidental appendec- tomy or prior conization did not affect infectious morbidity. Prophylactic antibiotics de- creased the incidence of pelvic abscess and/or cellulitis. Use of "low-dose" heparin was associated with a significant increase in operative blood loss. One patient, reoperated on for bowel obstruction, died of pulmonary embolus. Ureteral fistulae occurred in 1.1% of pa- tients not previously irradiated. Two bladder injuries and one ureteral injury were corrected intraoperatively; one postoperative ureterovaginal fistula was repaired surgically. Five-year survival for patients with stage 1B carcinoma of the cervix was 87%. Operative techniques are discussed. INTRODUCTION From August 1969 to April 1979, 2841 patients were referred to the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama Medical Center in Birmingham. Of this number, 226 patients underwent radical hysterectomy with bilateral pelvic lymphadenectomy as primary or supplementary therapy. Complete hospital charts were available on 207 patients, and have been reviewed to determine overall survival as well as intraoperative and postoperative morbidity. All operations were performed by five surgeons, mem- bers of the Division of Gynecologic Oncology. An attempt was made to correlate infectious complications with patient characteristics, preoperative preparation, and surgical technique. MATERIAL Radical hysterectomy was primary therapy for gynecologic malignancy in 193 patients (93.2%), while 14 patients (6.8%) received prior irradiation. Invasive Supported in part by Gynecologic Oncology Grant CA 12484, Gynecologic Cancer Education Grant CA 24118, and Clinical Cancer Education Grant CA 17965. 2 To whom reprints should be addressed. 207 0090-8258/81/020207-06501.00/0 Copyright © 1981by AcademicPress, Inc. All rights of reproductionin any form reserved.