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Risk Factors for Severe Infection Following Cesarean Delivery
Abstract Number: S 31
Abstract Type: Original Research
Surgical site infections are a common cause of postoperative morbidity. A review of nearly 6000 patients in the United Kingdom found a post-cesarean delivery (CD) infection rate of 13.8%, of which 84% developed after hospital discharge. A small subset of patients with the most severe infections cannot be treated with outpatient antibiotics. Instead they require hospital readmission and/or follow-up with infectious disease (ID) specialists. In this retrospective review, we identify patient, provider and system factors that may contribute to these severe infections.
Our ID service provided a pre-existing database of patients with post-CD infections requiring consultation. Each database patient was matched to 4 control patients by BMI, approximate surgical date, and skin preparation solution (chlorhexadine or povidone iodine). Medical records were reviewed for patient demographics, medical history, perinatal course and perioperative factors using a data collection sheet developed in collaboration with the ID service. Recursive partitioning was performed to identify predictive factors for severe post-CD infection. Scheduled and unscheduled patients were separated and characteristics of infected v. non-infected patients within those groups compared using Fisher's exact or student t-test where appropriate.
134 patients (27 infection and 108 control) were reviewed. Recursive partitioning identified unscheduled CD as the only significant risk factor for severe post-CD infection of the 34 parameters investigated. These factors include history of steroid use or diabetes, supplemental intraoperative O2 administration, anesthetic technique, duration of surgical procedure, skin closure method, PACU-admission temperature and use of post-operative tranversus abdominis plane block. When characteristics within scheduled and unscheduled groups were analyzed the only difference in infected v. non-infected patients was lowest hemoglobin for unscheduled CD (Table 1).
Established risk factors for all post-CD infection include BMI, age, blood loss, method of skin closure, emergency procedure, duration of procedure, number of prenatal consultations, and hypertension. Our study suggests the most severe post-CD infections occur in unscheduled CD, suggesting that unscheduled CD may contribute to overall risk for post-CD infections. This finding suggests a need for systems improvement aimed at decreasing infection risk following unscheduled CD.