Preoperative warming before clean surgery prevents wound infections and can avoid the use of prophylactic antibiotics.

Aims: Wound infection after clean surgery (the majority being hernias, varicose veins and breast) is underestimated; by using a trained and blinded observer with in depth surveillance, and appropriate definitions or wound scores, an infection rate of up to 15‰r more may be found. Equally controversial is the value of prophylactic antibiotics in preventing postoperative wound infections. Methods: Four hundred and twenty-one patients undergoing clean surgery were randomly assigned to a standard (nonwarmed) group or to local (L) or systemic (S) warming using either a Warm-up device or Bair Hugger (Augustine Medical). All patients were followed up by a blinded observer with a diary system using four wound-scoring systems. Results: In the standard group there were 19/139 infections (13.7 per cent), 5/138 in the L group (3.6 per cent) and 8/139 in the S group (5.8 per cent; P < 0.001). There were no increases in wound complications but the unwarmed patients received more courses of postoperative antibiotics (15.9 per cent) than warmed patients (6.5 per cent; P = 0.002). Conclusions: Warming patients prior to clean surgery reduces the wound infection rate and the indication for postoperative antibiotics and prophylactic antibiotics may not be required for clean wound surgery. Patients undergoing breast surgery have the highest wound infection rates, which may be avoided by preoperative warming to lessen delays waiting for chemotherapy or radiotherapy. [ABSTRACT FROM AUTHOR]

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