Preoperative vaginal preparation reduces postoperative systemic infectious complications in gynecologic surgery: a propensity score-matched retrospective cohort study.

BACKGROUND: Postoperative systemic infectious complications (PSIC) impose a substantial burden on clinical resources following gynecologic surgery. While international guidelines recommend preoperative vaginal preparation, high-quality evidence supporting its efficacy against PSIC remains limited. Furthermore, uptake varies widely in practice, often reflecting healthcare reform priorities such as Diagnosis-Related Groups (DRG) and Diagnosis-Intervention Packet (DIP). METHODS: We conducted a retrospective cohort study of 17,582 gynecologic surgery patients (January 2022-December 2024) at a southwestern Chinese tertiary hospital. Propensity score matching (PSM) produced 2,195 balanced pairs. The study outcome was the incidence of PSIC, assessed using an objective, EMR-based algorithmic definition. RESULTS: Vaginal preparation reduced PSIC incidence by nearly half (1.28% vs. 2.19%; adjusted OR = 0.623, 95% CI: 0.385-0.919, p = 0.040). The protective effect was robust across pre-specified subgroups, with marked risk reductions observed among patients undergoing open surgery, those using prophylactic antibiotics, anemic patients, and non-diabetics. CONCLUSIONS: Preoperative vaginal preparation reduced PSIC risk in this real-world cohort. This intervention proved particularly valuable for specific patient and procedural subgroups. As a cost-effective measure, it warrants inclusion in routine preoperative protocols, even within efficiency-driven frameworks such as Enhanced Recovery After Surgery (ERAS) and DRG/DIP.