Risk factors for surgical-site infections following cesarean section.
OBJECTIVE
To identify risk factors associated with surgical-site infections (SSIs) following cesarean sections.


METHODS
Prospective cohort study.


METHODS
High-risk obstetrics and neonatal tertiary-care center in upstate New York.


METHODS
Population-based sample of 765 patients who underwent cesarean sections at our facility during 6-month periods each year from 1996 through 1998.


METHODS
Prospective surgical-site surveillance was conducted using methodology of the National Nosocomial Infections Surveillance System. Infections were identified during admission, within 30 days following the cesarean section, by readmission to the hospital or by a postdischarge survey.


RESULTS
Multiple logistic-regression analysis identified four factors independently associated with an increased risk of SSI following cesarean section: absence of antibiotic prophylaxis (odds ratio [OR], 2.63; 95% confidence interval [CI95], 1.50-4.6; P=.008); surgery time (OR, 1.01; CI95, 1.00-1.02; P=.04); <7 prenatal visits (OR, 3.99; CI95, 1.74-9.15; P=.001); and hours of ruptured membranes (OR, 1.02; CI95, 1.01-1.03; P=.04). Patients given antibiotic prophylaxis had significantly lower infection rates than patients who did not receive antibiotic prophylaxis (P=02), whether or not active labor or ruptured membranes were present.


CONCLUSIONS
Among the variables identified as risk factors for SSI, only two have the possibility to be changed through interventions. Antibiotic prophylaxis would benefit all cesarean patients regardless of active labor or ruptured membranes and would decrease morbidity and length of stay. Women's healthcare professionals also must continue to encourage pregnant women to start prenatal visits early in the pregnancy and to maintain scheduled visits throughout the pregnancy to prevent perinatal complications, including postoperative infection.
Killian
C A
CA
Department of Epidemiology, Albany Medical Center, Albany, New York 12208, USA.
Graffunder
E M
EM
Vinciguerra
T J
TJ
Venezia
R A
RA
D000328:Adult; D019072:Antibiotic Prophylaxis; D002585:Cesarean Section / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D009518:New York / Q000453:epidemiology; D011159:Population Surveillance; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control