Abstract
(1) Background: Caesarean sections in obese patients are associated with an increased risk of surgical wound complications, including hematomas, seromas, abscesses, dehiscence, and surgical site infections. The aim of the present study is to perform a meta-analysis and systematic review of the current literature focusing on the strategies available to decrease wound complications in this population. (2) Methods: We reviewed the data available from the PubMed and the Science Direct databases concerning wound complications after caesarean sections in obese women. The following key words were used: “caesarean section”, “cesarean section”, “wound complication”, “wound morbidity”, and “wound infection”. A total of 540 papers were retrieved, 40 of which were selected for the final systematic review and whereas 21 articles provided data for meta-analysis. (3) Results: The conducted meta-analyses revealed that the use of prophylactic drainage does not increase the risk of wound complications in obese women after a caesarean sections (pooled OR = 1.32; 95% CI 0.64–2.70, p = 0.45) and that vertical skin incisions increase wound complications (pooled OR = 2.48; 95% CI 1.85–3.32, p < 0.01) in obese women, including extremely obese women. (4) Conclusions: Subcutaneous drainage does not reduce the risk of a wound complications, wound infections, and fever in obese women after caesarean sections. Negative prophylactic pressure wound therapy (NPWT) may reduce the risk of surgical site infections. The evidence of using a prophylactic dose of an antibiotic before the caesarean section is still lacking.
Highlights
Obesity is a chronic disease that leads to the development of metabolic disorders and cardiovascular complications and currently poses a challenge for healthcare systems around the world [1]
A superficial surgical site infection, an infection involving only the skin or subcutaneous tissue occurring within 30 days of surgery with at least one of the following: purulent drainage from the wound or organism identified by culture or wound deliberately opened by the surgeon
The use of a prophylactic dose of antibiotic in women undergoing a caesarean section Thethe userisk of aofprophylactic dose of antibiotic in women undergoing a caesarean reduces postoperative wound infections (RR 0.40; 95% CI 0.35–0.46, 82) secand tion reduces the risk of postoperative wound infections
Summary
Obesity is a chronic disease that leads to the development of metabolic disorders and cardiovascular complications and currently poses a challenge for healthcare systems around the world [1]. In 2016, 15% of women over 18 years of age were either overweight or obese [2]. This problem affects 1/3 of women of reproductive age [3], including 13% of pregnant women [4]. Obese women develop arterial hypertension [7] and diabetes more often in pregnancy and undergo caesarean sections significantly more often [8], which means that they are diagnosed with postoperative surgical wound healing disorders more frequently [9]
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