Study reveals risk Factors Associated with Surgical Site Infection following Cesarean Section
Cesarean section (CS) is one of the most performed major surgical procedures in obstetrics. When adequately indicated, it can prevent poor obstetric outcomes and can be a life-saving procedure for both the mother and the fetus. Nevertheless, at a time when the cesarean delivery rate has been rising globally, concern is growing about the risk of maternal mortality and morbidity that comes with it parallelly. Major complications associated with cesarean delivery include postpartum endometritis, hemorrhage, injury to pelvic organs, thromboembolic disorders, anesthesia-related complications, and wound complications.
Surgical site infection (SSI) is an infection that occurs within 30 days after the operation and involves the skin and subcutaneous tissue of the incision (superficial incisional) and/or the deep soft tissue (for example, fascia and muscle) of the incision (deep incisional) and/or any part of the anatomy (for example, organs and spaces) other than the incision that was opened or manipulated during an operation (organ/space). It is the most common infection in surgical patients and a major cause of maternal morbidity and mortality too.
Readmission of postpartum women in the hospital not only adds burden to the hospital and healthcare staff but also causes the huge impact on psychosocial health of a mother. Therefore, identifying risk factors for SSI in a hospital setting might be of importance to reduce maternal morbidity and mortality. The main objective of this study was to determine the incidence of SSI following CS in TUTH, classify them, and analyze different host, pregnancy, and procedure-related risk factors.
This was a case-control study conducted at the Department of Obstetrics and Gynecology at Tribhuvan University Teaching Hospital (TUTH), main campus of Institute of Medicine (IOM), Kathmandu, Nepal. Surgical site infections (SSI) in patients who underwent cesarean sections from February 2019 to August 2019 were taken as cases, while the patients who underwent cesarean section before or after the procedure and did not develop SSI comprised the controls. Visual inspection during ward rounds, reports from laboratory, and postprocedure follow-ups for up to 30 days formed the basis of identifying infections on the patients. Risk factors were identified by bivariate and multivariate logistic regression.
Out of 1135 cases of cesarean sections, 97 of them developed SSI with incidence rate of 8.54%. Among them, 94.85% were superficial incisional and 5.15% were deep incisional type of SSI with no organ space type. Cases had higher mean age 26:88 ± 4:38 years compared to 24:81 ± 5:08 years in controls. Host-related risk factors which led to higher odds of developing surgical site infection (SSI) were obesity with adjusted odds ratio (AOR) 15.72 (confidence interval (CI): 4.60-53.67), diabetes/hypertension in pregnancy with AOR 4.75(CI 1.69-13.32), and other medical diseases with AOR 9.38 (CI 2.89-30.46). Duration of the rupture of membrane for more than 18 hours with AOR 8.38 (CI 1.48-47.35), more than five per vaginal (PV) examination with AOR 1.93 (95% CI 1.03-3.64), and in labor status with AOR 6.52 (CI 1.17-36.38) were some procedure-related factors resulting into higher odds of infection.
Surgical site infection following cesarean section is a common complication with incidence of 8.54% in TUTH,IOM, Nepal. Multiple risk factors like increasing age, obesity, medical complications during pregnancy, initiation of labor during cesarean section, prolonged duration of rupture of membrane for more than 18 hours, and more than five PV examination increase the chance of surgical site infection after cesarean section. Hence, obstetrician should consider earlier or more frequent postoperative follow-up in patients with these risk factors. Obstetrician should try to avoid preventable risk factors to reduce incidence of surgical site infection following cesarean section.
Source: Astha Regmi , 1 Neebha Ojha,2 Meeta Singh; Hindawi International Journal of Reproductive Medicine Volume 2022, Article ID 4442453, 11 pages https://doi.org/10.1155/2022/4442453
