Cesarean Section Incision Complications and Associated Risk Factors: A Quality Assurance Project

Abstract

Background: Today in the United States, approximately 30% of deliveries are performed by cesarean section. Wound infections and other post-operative complications represent a frequent morbidity which may be improved with an understanding of local risk factors. Objective: This project used a retrospective analysis of cesarean section incision complications and infection events along with patient chart information to identify potential risk factors associated with incisional wound complications at our institution. Methods: ICD9 codes identified 618 cesarean sections from July 2012 through June 2013. Of these, 59 were excluded. Twelve different data elements were examined and complications were divided into two categories: presence of infection and presence of seroma/hematoma. Statistics included univariate analysis and multiple logistic regressions to identify an odds ratio for associations using P < 0.05 as significant. Results: 73 (13.1%) of 559 patients developed a post-partum incision complication. Five logistic variables were included in amultiple logistic regression model for all incision complications. Three of the five variables had a significant odds ratio: emergent cesarean section, stapled skin closure, and preeclampsia. Five logistic variables were included in another multiple logistic regression model for all wound infections. Two of the five variables had a significant odds ratio: BMI > 33.4 and preeclampsia. Conclusions: Cesarean section rates account for approximately 30% of deliveries, with significant maternal morbidity associated with incisional wound complications. This study found multiple significant risk factors for both wound complications and infections. Preeclampsia was an indepen-* Corresponding author. C. Newlin et al. 790 dent risk factor for both wound complications and infections.

Magnitude and determinants of surgical site infecion among women underwent cesarean section in Ayder comprehensive specialized hospital Mekelle City, Tigray region, Northern Ethiopia, 2016

“…The maternal infection following delivery increases by eight-fold when delivered by cesarean section than vaginal delivery. Based on studies related to SSI following caesarean section, the proportion of the SSI ranges from 3 to 15% [6].…”

Causes of Surgical Wound Dehiscence: A Multicenter Study

“…Various causes of wound dehiscence include surgical experience, surgical incision, suture material, and patient factors such as age, nutritional status, and other accompanying diseases [1,[4][5][6]. Preoperative risk factors include poor laboratory findings, infection, hypertension, and emergency surgery [1].…”

“…It is required to reduce the incidence of wound dehiscence through preoperative control of these areas. Postoperative risk factors include abdominal distension, excessive coughing, vomiting, and constipation [5], and resolving these symptoms with appropriate medication may reduce the likelihood of wound dehiscence In this study, we retrospectively reviewed patients who underwent wound revision due to wound dehiscence with reference to various causes. We reviewed the operative and other medical history prior to wound revision and analyzed the causes of wound dehiscence.…”

“…In the United States, about one-third of all mothers undergo C/Sec, and 15% of all deliveries worldwide are performed by C/Sec [8]. Despite the generalization of C/sec, marital morbidity and mortality risk are still higher than vaginal delivery [5,8]. Wound dehiscence and infection after C/Sec are important causes of postoperative morbidity and account for 10% of pregnancy-related mortality [10].…”

Surgical Site Infection following Emergency Caesarean Section incidence and associated risk factors: a retrospective case-control study.

“…Indeed, obesity, age and pre-eclampsia have been linked to post-surgical complications, possibly compounding wound healing and increasing the risk of infection. 25,26 Extended labour time and the complexities surrounding an emergency CS also impact the possibility of post-surgical infection. 27,28 However, there are some inconsistences; in a multicentre study of 4107 women who underwent a CS at 14 NHS hospitals in England, Wloch et al 29 found obesity (defined as BMI>30 kg/m 2 ), age <20 years and grade of surgeon to be significantly associated with developing an SSI.…”