Incidence and risk factors for surgical wound complications in women with body mass index >30 kg/m2 following cesarean delivery: a secondary analysis

Abstract

BACKGROUNDSurgical wound complications are common and occur in between 3% and 12% of obese women after cesarean delivery. An understanding of the risk factors for wound complications may inform potential areas for clinical care improvement.OBJECTIVEThis study aimed to identify the incidence and predictors of surgical wound complications in obese women after cesarean delivery.STUDY DESIGNThis was a secondary analysis of the ADding negative pRESSure to improve healING, or DRESSING, randomized controlled trial conducted at 4 maternity hospitals in Australia. A total of 2035 women with a prepregnancy body mass index ≥30 kg/m2 undergoing cesarean delivery were included. Data were collected between October 2015 and December 2019 using self-reporting of signs and symptoms, the research nurses’ direct observation of the surgical site, and medical records. Independent blinded outcome assessors ascertained wound outcomes on the basis of self-reported data and medical records. Multivariable logistic regression models were used to identify independent risk factors for wound complications and surgical wound dehiscence. The 30-day cumulative incidence of wound complications and surgical wound dehiscence was calculated.RESULTSOf the 2035 women, 317 (15.6%) developed a wound complication, whereas 211 (10.4%) developed surgical wound dehiscence. The predictors of a wound complication included 1 previous cesarean delivery (odds ratio, 1.41; 95% confidence interval, 1.05–1.90; P=.02) and ruptured membranes >12 hours (odds ratio, 1.69; 95% confidence interval, 1.08–2.66; P=.02). The odds of developing any wound complication decreased by 45% with vaginal cleansing (odds ratio, 0.55; 95% confidence interval, 0.42–0.72; P<.001) and by 59% for low transverse incision (odds ratio, 0.41; 95% confidence interval, 0.18–0.94; P=.04). The predictors of surgical wound dehiscence included 1 previous cesarean delivery (odds ratio, 1.62; 95% confidence interval, 1.14–2.31; P=.008) and ruptured membranes >12 hours (odds ratio, 1.85; 95% confidence interval, 1.10–3.12; P=.02). The odds of developing surgical wound dehiscence decreased by 50% for vaginal cleansing (odds ratio, 0.50; 95% confidence interval, 0.36–0.69; P<.001) and by 42% for using a double-layer uterine closure (odds ratio, 0.58; 95% confidence interval, 0.35–0.97; P=.04).CONCLUSIONWound complications and surgical wound dehiscence in this population are high. The predictors observed herein would assist in identifying high-risk women. Such information may guide patient-centered decision-making in the planning of surgical births and individualized postoperative care.