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


CONCLUSIONS
Multiple patient, provider, and procedure-specific risk factors contribute to CD SSI risk which may be targeted in infection-control efforts.
Department of Obstetrics, Gynecology and RS, University of Pittsburgh, Pittsburgh, Pennsylvania.
Raj
R
Shree
Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania.
Seo Young
SY
Park
Department of Obstetrics, Gynecology and RS, University of Pittsburgh, Pittsburgh, Pennsylvania.
Richard H
RH
Beigi
Department of Obstetrics, Gynecology and RS, University of Pittsburgh, Pittsburgh, Pennsylvania.
Shannon L
SL
Dunn
Department of Obstetrics, Gynecology and RS, University of Pittsburgh, Pittsburgh, Pennsylvania.
Elizabeth E
EE
Krans
D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002585:Cesarean Section; D002821:Chorioamnionitis / Q000453:epidemiology*; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007396:Internship and Residency / Q000706:statistics & numerical data; D007743:Labor, Obstetric; D016015:Logistic Models; D008484:Medicaid / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009774:Obstetrics / Q000193:education; D016017:Odds Ratio; D011247:Pregnancy; D011331:Private Practice / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*; D064424:Tobacco Use / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014592:Uterine Hemorrhage / Q000453:epidemiology; D055815:Young Adult