Surgical Site Infection following Cesarean Delivery: Patient, Provider, and Procedure-Specific Risk Factors

Abstract

Objective: This study aims to identify risk factors for cesarean delivery (CD) surgical site infection (SSI). study design: Retrospective analysis of 2,739 CDs performed at the University of Pittsburgh in 2011. CD SSIs were defined using National Healthcare Safety Network (NHSN) criteria. Chi-square test and t-test were used for bivariate analyses and multivariate logistic regression was used to identify SSI risk factors.

Results: Of 2,739 CDs, 178 (6.5%) were complicated by SSI. Patients with a SSI were more likely to have Medicaid, have resident physicians perform the CD, an American Society of Anesthesiologists (ASA) class of ≥ 3, chorioamnionitis, tobacco use, and labor before CD. In multivariable analysis, labor (odds ratio [OR], 2.35; 95% confidence interval [95% CI], 1.65-3.38), chorioamnionitis (OR, 2.24; 95% CI, 1.25-3.83), resident teaching service (OR, 2.15; 95% CI, 1.54-3.00), tobacco use (OR, 1.70; 95% CI, 1.04-2.70), ASA class ≥ 3 (OR, 1.61; 95% CI, 1.06-2.39), and CDs performed for nonreassuring fetal status (OR, 0.43; 95% CI, 0.26-0.67) were significantly associated with CD SSI.

Conclusion: Multiple patient, provider, and procedure-specific risk factors contribute to CD SSI risk which may be targeted in infection-control efforts.

Conflict of interest statement

Statement: None of the authors have a conflict of interest to report.

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Figures

Figure 1

Centers for Disease Control and Prevention’s National Healthcare Safety Network classification for surgical site infection (SSI) • Adapted from Centers for Disease Control and Prevention’s National Healthcare Safety Network classification for surgical site infection (SSI). http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf