Risk factors for surgical site infection following cesarean delivery: a retrospective cohort study

Abstract

Background:The rate of cesarean delivery is increasing in North America. Surgical site infection following this operation can make it difficult to recover, care for a baby and return home. We aimed to determine the incidence of surgical site infection to 30 days following cesarean delivery, associated risk factors and whether risk factors differed for predischarge versus postdischarge infection. Methods:We identified a retrospective cohort in Nova Scotia by linking the provincial perinatal database to hospital admissions and physician billings databases to follow women for 30 days after they had given birth by cesarean delivery between Jan. 1, 1997 and Dec. 31, 2012. Logistic regression with generalized estimating equations was used to determine risk factors for infection.Results: A total of 25 123 women had 33 991 cesarean deliveries over the study period. Of the 25 123, 923 had surgical site infections, giving an incidence rate of 2.7% (95% CI 2.54%-2.89%); the incidence decreased over time. Risk factors for infection (adjusted odds ratios ≥ 1.5) were prepregnancy weight 87.0 kg or more, gaining 30.0 kg or more during pregnancy, chorioamnionitis, maternal blood transfusion, anticoagulation therapy, alcohol or drug abuse, second stage of labour before surgery, delivery in 1997-2000 and delivery in a hospital performing 130-1249 cesarean deliveries annually. Women who gave birth earlier in the study period, those who gave birth in a hospital with 130-949 cesarean deliveries per year and those with more than 1 fetus were at a significantly higher risk for surgical site infection before discharge; women who smoked were at significantly higher risk for surgical site infection after discharge.Interpretation: Most risk factors are known before delivery, and some are potentially modifiable. Although the incidence of surgical site infection decreased over time, targeted clinical and infection prevention and control interventions could further reduce the burden of illness associated with this health-care-related infection. Abstract ResearchResearch CMAJ OPEN CMAJ OPEN, 5(3) E547

Prevalence of surgical site infection and associated factors after cesarean section in Ethiopia: systematic review and meta-analysis

“…Mothers who were diagnosed positive for chorioamnionitis had increased risk of SSI following cesarean section than mothers who don't diagnosed for chorioamnionitis. Consistent finding was also reported from Canada, Australia and Estonia [38,46,50] . Chorioamnionitis is the inflammation of feto-placental membrane that can increase the chance of ascending or iatrogenic infection.…”

“…This includes limited and ineffective administering of antimicrobials before 1hr of procedure, prolonged preoperative admission of patients, longer duration of procedures and inability to prevent obstetric complications (PROM, chorioamnionitis) [36]. It was also much higher than among studies conducted in Nova Scotia and New Zealand reports of SSI prevalence; 2.7% and 5.2% [37,38]respectively.…”

Patient comorbidities as risk factors for surgical site infection in gynecologic and obstetric surgery

“…Despite this similarity, it should be mentioned that none of the patients in this study were illiterate. 14 In the present study, history of smoking was recorded in 43.2% of the patients, almost double than that found by Ketcheson et al in 2017, where he reported that 27.1% of the patients undergoing cesarean section smoked. 15 The most frequent comorbidities were obesity followed by hypertension, similar to the study carried out in England in 2013, where they also associated high BMI, tobacco consumption, chronic hypertension and leukocytosis with an increased risk of wound infection.…”

“…14 In the present study, history of smoking was recorded in 43.2% of the patients, almost double than that found by Ketcheson et al in 2017, where he reported that 27.1% of the patients undergoing cesarean section smoked. 15 The most frequent comorbidities were obesity followed by hypertension, similar to the study carried out in England in 2013, where they also associated high BMI, tobacco consumption, chronic hypertension and leukocytosis with an increased risk of wound infection. 16 On the other hand, in the study conducted in Cuba in 2014, the main comorbidity was anemia, followed by obesity and hypertension.…”

Prevalence of surgical site infection and associated factors after cesarean section in Ethiopia: systematic review and meta-analysis

“…The association between PROM more than 12hrs and SSI after cesarean section was reported in five [28] In contrast the finding is much higher than studies conducted in Nova Scotia and New Zealand which reported with prevalence SSI 2.7% and 5.2% [29,30]respectively.…”