Febrile morbidity and hospital stay in high-risk cesarian section patients at a non-teaching hospital.
Objective: The objective of the study was to determine the incidence of postcesarian febrile morbidity and relate this to hospital stay in a high-risk indigent population treated at a private non-teaching hospital.Methods: This was a retrospective chart review of all patients done between January 1995 and December 1996. Discharge summaries, antepartums, progress notes, and labs were reviewed for each patient. Of 257 charts reviewed, 5 were inadequate for various reasons. Board-certified surgeons performed and assisted in the operations. Twenty-one patients had scant prenatal care and 6 had no prenatal care. All patients had the abdomen scrubbed with Betadine soap prior to painting. No shaving was done. Gloves were changed after closure of uterine incision. The pelvis was copiously irrigated with 3-4 L of saline. The subcutaneous layer was irrigated from a height of 6-12" with 12 to 1 L of fluid. After this step, this layer is not touched by anything from the operating field.Results: Of 162 patients with primary cesarian, 20 had postoperative fever, 18 with endometritis, 2 with wound infections. All but 5 of these patients had labor as ruptured membranes of 12 hours or more. Four had prolonged 2nd stage. Of 28 failed VBACs, 2 had fever vs none for 59 elective repeat cesarians. The average hospital stay for febrile patients was 4.4 days vs 2.7 for afebrile patients. The incidence of wound infection was 0.8%. The incidence of fever was 12.2% for primary cesarians and 8.8% in the total study group of 249 patients.Conclusion: This study demonstrates that the adoption of simple measures presented in Methods can dramatically decrease the incidence and severity of postcesarian fever, especially wound infection, thereby allowing safe, early hospital discharge.
Persad
SI
Assistant Clinical Professor OB GYN, MCG Candler General Hospital, Georgia, Savannah, USA