Surgical Site Infection following Emergency Caesarean Section incidence
and associated risk factors: a retrospective case-control study.
Abstract
Objective: To quantify the incidence, risk and associated factors that
contribute to the development of Surgical Site Infection (SSI) in
emergency Caesarean Section (CS). Design: A retrospective case-control
study. Setting: An acute District General Hospital in England. Sample:
206 patients (101 SSI patients and 105 non-SSI patients) who had
emergency CS between January-December 2017. Methods: Grade of surgeon,
smoking status, pre-operative vaginal swab, diabetes status, age, body
mass index (BMI), membrane rupture to delivery interval and length of
surgery were recorded. Risk factors significantly associated with SSI
were identified using simple and multiple logistic regression
procedures. Results: BMI (kg/m2) was significantly associated with SSI
occurrence and age (odds ratio (OR) 1.17; 95% confidence interval (CI)
1.11 to 1.24; p<0.001). Substantive non-significant
associations were recorded between SSI, patient age and vaginal swab.
Conclusion: This study identified BMI as the only significant risk
factor from a range of patient-level factors for the development of an
SSI in emergency CS, possibly due to the impact of excessive adipose
tissue on the body’s immune system and reduced effectiveness of
antibiotics. The importance of appropriate wound management including
frequent wound cleaning, appropriate dressings and dressing change and
education is highlighted. Improved guidelines and strategies for
managing at-risk patients would enable clinicians to manage emergency CS
patients better and reduce the risk of SSI development. Diabetes status,
patient age and pre-op vaginal swab were not significantly associated
with SSI in emergency CS. Future research on larger samples should be
conducted to validate these findings.