767 Cesarean wound outcomes among super obese women

Abstract

To evaluate the difference in wound outcomes among super obese (BMI >50 kg/m2) and obese (BMI 30-49.9 kg/m2) women undergoing cesarean delivery. This is a secondary analysis of a single site randomized clinical trial of women who underwent cesarean delivery between September 2013 and June 2016. Participants in the original study were randomized to a silver nylon dressing versus standard gauze dressing. Inclusion criteria included completion of > 36 gestational weeks, receipt of preoperative antibiotics, and scheduled or unscheduled cesarean delivery via Pfannenstiel incision. In this secondary analysis, patient characteristic of women with BMI >50 kg/m2 were compared to women with BMI 30-49.9 kg/m2 using chi-square, Students T-test, and logistic regression to generate adjusted odds ratios and 95% confidence intervals. P-value < 0.5 was considered significant. Among the 657 participants who underwent randomization, 470 were noted to have BMI >30 kg/m2. Within this cohort of obese women, 50 (10.6%) had a BMI >50 kg/m2. Sociodemographic data was similar among the groups. Women in the obese and super obese groups were similar with regard to labor prior to cesarean (30.8% vs 38.8%, p=0.255), smoking status in pregnancy (6.2% vs 0%, p=0.18), chorioamnionitis (3.3% vs 6.0%, p=0.34), and diabetes type 1 (2.1% vs 2.0%, p=0.947). Compared to women BMI 30-49.9 kg/m2, super obese women had higher rates of gestational diabetes (22% vs 8.1%, p< 0.001), diabetes type 2 (14% vs 5%, p=0.011), chronic hypertension (52% vs 15.7%, p< 0.001), and prior cesarean delivery (26.5% vs 12.6%, p=0.008). Women in the super obese category were more likely to have any wound infection (aOR 2.95 [1.14-7.62]). Composite outcome for wound complication was not statistically significantly increased for the super obese cohort (aOR 1.7 [0.73-4.09]). History of prior cesarean delivery was independently associated with increased risk of wound infection. Women with BMI > 50 kg/m2 undergoing cesarean delivery were more likely to have a wound infection compared to obese counterparts.