Independent Risk Factors for Surgical Site Infection after Cesarean Delivery in a Rural Tertiary Academic Medical Center
Abstract Number: T-02
Abstract Type: Original Research
Introduction: We aimed to determine the incidence of surgical site infection (SSI) after cesarean delivery (CD) and identify risk factors for SSIs in a rural tertiary academic medical center.
Methods: After local institutional review board approval, we conducted a time matched, case control, quality assurance analysis. Over a 6.5 year period, 218 patients with a SSI were identified based on ICD code and matched to a control group of 3,131 parturients from the Integrated Data Repository quality assurance medical record database. Data is presented as mean ± SD with 95% CI, median with range in parenthesis, or percentage with Odds Ratio (OR) and analyzed using t-test or Chi-square. A P < 0.05 is significant.
Results: The overall incidence of SSI after CD was 7.0%. No differences were noted with respect to age, ethnicity, height, insurance, prenatal care visits, prior antibiotic use, prior CD, GBS colonization, steroid use, malpresentation, cervical incompetence, diagnosis of chorioamnionitis or maternal fever, history of diabetes, SLE, STD, or preeclampsia, use of Foley bulb, number of vaginal exams, vaginal bleeding during pregnancy, use of internal fetal monitor, need for amnioinfusion, presence of meconium at birth, emergency CD, STAT CD, time between admission and CD, intraoperative antibiotic use, gestational age, Apgar score, and child birth weight. Significant differences did occur in BMI 40.30 ± 10.60 kg/m2 SSI (95% CI: 38.73-41.87) vs. 34.05 ± 8.24 kg/m2 control (95% CI: 33.75-34.35, P < 0.001), highest level of education 13.28 ± 2.44 yr. SSI (95% CI: 12.9-13.66) vs. 14.07 ± 2.81 yr. control (95% CI: 13.96-14.18, P < 0.001), and prior births 2 (1-9) SSI vs. 1 (1-11) control (P < 0.001). Table 1 lists additional independent risk factors for SSI after CD.
Conclusions: In addition to higher BMI, lower education level, and history of higher parity, we found that tobacco use, a diagnosis of hypertension and gestational diabetes to be independent risk factors for SSI. Conversely, the presence of ruptured membranes, an elective or urgent CD, and a low transverse incision were protective against a SSI after CD.