1054 Predictors of surgical-site infection after cesarean delivery in obese women receiving evidence-based preventive measures

Abstract

Obesity increases the risk of both cesarean delivery and surgical site infections. Our objective was to estimate patient and operative predictors of surgical-site infection after cesarean in a contemporary cohort of obese women who received evidence-based preventive measures. Secondary analysis of data from a multicenter randomized trial in which obese women (pre-pregnancy BMI > 30kg/m2) undergoing planned or unplanned cesarean delivery were randomized to either prophylactic negative pressure wound therapy (n=806) or standard wound dressing (n=802). Participants received standard evidence-based infection prevention measures. The primary outcome was superficial, deep or organ-space surgical-site infection according to the Centers for Disease Control and Prevention definitions. Univariable and multivariable analysis were used to estimate independent patient and surgical predictors of surgical site infection. Of the 1608 participants, 60 (3.7%) were diagnosed with surgical site infection. There was no significant difference in surgical-site infection by randomization group, and the two groups were combined for this analysis. Several patient and surgical characteristics were associated with a higher risk of surgical site infection. In multivariable analysis, tobacco use, chorioamnionitis and depth of subcutaneous tissue were associated with an increased risk of surgical site infection. Use of cefazolin prophylaxis, compared with non-cefazolin antibiotics, was associated with lower risk (Table). The multivariable model based on these variables was moderately predictive (area under the curve: 0.70, Figure). The risk of surgical-site infection in obese women after cesarean is relatively low when evidence-based preventive measures are used. Smoking cessation, closure of the subcutaneous layer and cefazolin prophylaxis may be modifiable factors to further minimize infection risk in this population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)