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Erritty M, Hale J, Thomas J, Thompson A, Wright R, Low A, Carr M, George R, Williams L, Dumitrescu A, Rees J, Irukulla S, Robin J, Fry CH, Fluck D, Han TS. Evaluation of independent risk factors associated with surgical site infections from caesarean section. Arch Gynecol Obstet 2023; 308:1775-1783. [PMID: 36567354 PMCID: PMC10579128 DOI: 10.1007/s00404-022-06885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/13/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The present study assessed factors associated with the risk of surgical site infections (SSI) after a caesarean section (C-section). METHODS Data were collected in 1682 women undergoing elective (53.9%) and emergency (46.1%) C-sections between 1st August 2020, and 30th December 2021, at a National Health Service hospital (Surrey, UK). RESULTS At the time of C-section, the mean age was 33.1 yr (SD ± 5.2). Compared to women with BMI < 30 kg/m2, those with a BMI ≥ 35 kg/m2 had a greater risk of SSI, OR 4.07 (95%CI 2.48-6.69). Women with a history of smoking had a greater risk of SSI than those who had never smoked, OR 1.69 (95%CI 1.05-2.27). Women with a BMI ≥ 30 kg/m2 and had a smoking history or emergency C-section had 3- to tenfold increases for these adverse outcomes. Ethnic minority, diabetes or previous C-section did not associate with any of the outcomes. CONCLUSIONS High BMI, smoking, and emergency C-section are independent risk factors for SSI from C-section. Women planning conception should avoid excess body weight and smoking. Women with diabetes and from ethnic minority backgrounds did not have increased risks of SSI, indicating a consistent standard of care for all patients.
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Affiliation(s)
- Matthew Erritty
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Joann Hale
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - James Thomas
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Anna Thompson
- Surgical Site Infection Surveillance Team, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Ria Wright
- Surgical Site Infection Surveillance Team, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Anna Low
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Megan Carr
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Richard George
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Lisa Williams
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Alexandra Dumitrescu
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Jacqui Rees
- Department of Quality, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Shashi Irukulla
- Surgical Site Infection Surveillance Team, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Jonathan Robin
- Department Acute Medicine, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Thang S Han
- Department of Endocrinology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK.
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, TW20 0EX, Surrey, UK.
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Carshon-Marsh R, Squire JS, Kamara KN, Sargsyan A, Delamou A, Camara BS, Manzi M, Guth JA, Khogali MA, Reid A, Kenneh S. Incidence of Surgical Site Infection and Use of Antibiotics among Patients Who Underwent Caesarean Section and Herniorrhaphy at a Regional Referral Hospital, Sierra Leone. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074048. [PMID: 35409731 PMCID: PMC8998544 DOI: 10.3390/ijerph19074048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 12/22/2022]
Abstract
Surgical site infections (SSIs) are common postoperative complications. Surgical antibiotic prophylaxis (SAP) can prevent the occurrence of SSIs if administered appropriately. We carried out a retrospective cohort study to determine the incidence of SSIs and assess whether SAP were administered according to WHO guidelines for Caesarean section (CS) and herniorrhaphy patients in Bo regional government hospital from November 2019 to October 2020. The analysis included 681 patients (599 CSs and 82 herniorrhaphies). Overall, the SSI rate was 6.7% among all patients, and 7.5% and 1.2% among CS patients and herniorrhaphy patients, respectively. SAP was administered preoperatively in 85% of CS and 70% of herniorrhaphy patients. Postoperative antibiotics were prescribed to 85% of CS and 100% of herniorrhaphy patients. Ampicillin, metronidazole, and amoxicillin were the most commonly used antibiotics. The relatively low rate of SSIs observed in this study is probably due to improved infection prevention and control (IPC) measures following the Ebola outbreak and the current COVID-19 pandemic. A good compliance rate with WHO guidelines for preoperative SAP was observed. However, there was a high use of postoperative antibiotics, which is not in line with WHO guidelines. Recommendations were made to ensure the appropriate administration of SAP and reduce unnecessary use of antibiotics.
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Affiliation(s)
- Ronald Carshon-Marsh
- District Health Management Team, Ministry of Health and Sanitation (MOHS), Bo District, Bo City 00232, Sierra Leone
- Correspondence: ; Tel.: +232-79884881
| | - James Sylvester Squire
- National Disease Surveillance Programme, Directorate of Health Security and Emergencies, MOHS, Cockerill, Wilkinson Road, Freetown 00232, Sierra Leone; (J.S.S.); (K.N.K.)
| | - Kadijatu Nabbie Kamara
- National Disease Surveillance Programme, Directorate of Health Security and Emergencies, MOHS, Cockerill, Wilkinson Road, Freetown 00232, Sierra Leone; (J.S.S.); (K.N.K.)
| | | | - Alexandre Delamou
- Department of Public Health, Gamal University of Conakry, Conakry BP 1147, Guinea;
| | - Bienvenu Salim Camara
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Maferinyah National Center for Training and Research in Rural Health, Forécariah BP 2649, Guinea;
| | | | - Jamie Ann Guth
- Global Health Connections, Center Barnstead, Barnstead, NH 03225, USA;
| | - Mohamed Ahmed Khogali
- Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organisation, Avenue Appia 20, 1211 Geneva, Switzerland;
| | - Anthony Reid
- Operational Research Unit Luxembourg, Medecins Sans Frontieres/Doctors without Borders, 68 Rue Gasperich, L-1617 Luxembourg, Luxembourg;
| | - Sartie Kenneh
- Office of the Chief Medical Officer, Ministry of Health and Sanitation, 4th Floor, Youyi Building, Brookfields, Freetown 00232, Sierra Leone;
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Onuzo CN, Sefogah PE, Nuamah MA, Ntumy M, Osei MM, Nkyekyer K. SURGICAL SITE INFECTIONS FOLLOWING CAESAREAN SECTIONS IN THE LARGEST TEACHING HOSPITAL IN GHANA. Infect Prev Pract 2022; 4:100203. [PMID: 35265827 PMCID: PMC8898913 DOI: 10.1016/j.infpip.2022.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/27/2022] [Indexed: 11/26/2022] Open
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Ngonzi J, Bebell LM, Boatin AA, Owaraganise A, Tiibajuka L, Fajardo Y, Lugobe HM, Wylie BJ, Jacquemyn Y, Obua C, Haberer JE, Geertruyden JPV. Impact of an educational intervention on WHO surgical safety checklist and pre-operative antibiotic use at a referral hospital in southwestern Uganda. Int J Qual Health Care 2021; 33:6352323. [PMID: 34390247 DOI: 10.1093/intqhc/mzab089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/31/2021] [Accepted: 06/05/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The World Health Organization (WHO) recommends adherence to its surgical safety checklist (SSC) to optimize patient safety and reduce cesarean surgical site infection (SSI). Educational interventions combined with audit and feedback mechanisms on the checklist use by clinicians have the potential to improve adherence and clinical outcomes. Despite the increase in cesarean delivery rates, there is a paucity of data on how such interventions can improve adherence in resource-limited settings. OBJECTIVE We performed a quality improvement project to measure the impact of an educational intervention with daily audit and feedback procedures on rates of WHO SSC adherence, including pre-operative antibiotic administration and SSI at Mbarara Regional Referral Hospital maternity ward in Uganda. METHODS The study involved chart abstraction of WHO SSC and pre-operative antibiotic use during cesarean deliveries and signs of subsequent SSI in three phases. First, we conducted a retrospective review of all charts from May to June 2018 (pre-intervention phase). Second, we instituted an educational intervention on the WHO SSC and pre-operative antibiotics use, followed by a daily audit of charts and feedback to clinicians from July to August 2018 (the intervention phase). Third, we reviewed charts from September to October 2018 (the post-intervention phase). The WHO SSC adherence, pre-operative antibiotic administration and SSI rates were measured as the proportion of the total cesarean deliveries per study phase and then compared across the three phases. RESULTS We reviewed 678 patients' charts (200 in the pre-intervention phase, 230 in the intervention phase and 248 in the post-intervention phase). The mean patient age was 25 years. The use of the WHO SSC was 7% in the pre-intervention phase compared to 92% in the intervention phase (P < 0.001), and 77% in the post-intervention phase (P < 0.001). Pre-intervention antibiotic receipt was 18% compared to 90% in the intervention phase (P < 0.001) and 84% in the post-intervention phase (P < 0.001). The documented SSI rate in the pre-intervention phase was 15% compared to 7% in the intervention phase (P = 0.02) and 11% in the post-intervention phase (P = 0.20). CONCLUSIONS An educational intervention, daily audit and feedback to clinicians increased the use of the WHO SSC and prophylactic antibiotics for cesarean delivery-although the rates waned with time. Research to understand factors influencing the checklist use and antibiotic prophylaxis including prescriber knowledge, motivation and clinical process is required. Implementation interventions to sustain usage and impact on clinical outcomes need to be explored.
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Affiliation(s)
- Joseph Ngonzi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda +256
| | - Lisa M Bebell
- Massachusetts General Hospital and Harvard Medical School, 125 Nashua St, Suite 722, Boston, MA 02114, USA
| | - Adline A Boatin
- Massachusetts General Hospital and Harvard Medical School, 125 Nashua St, Suite 722, Boston, MA 02114, USA
| | - Aspihas Owaraganise
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda +256
| | - Leevan Tiibajuka
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda +256
| | - Yarine Fajardo
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda +256
| | - Henry Mark Lugobe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda +256
| | - Blair J Wylie
- Massachusetts General Hospital and Harvard Medical School, 125 Nashua St, Suite 722, Boston, MA 02114, USA
| | - Yves Jacquemyn
- Global Health Institute, University of Antwerp, Wilrijkstraat 10; 2650 Edegem, Antwerp, Belgium
| | - Celestino Obua
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara +256, Uganda
| | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, 125 Nashua St, Suite 722, Boston, MA 02114, USA
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Kvalvik SA, Rasmussen S, Thornhill HF, Baghestan E. Risk factors for surgical site infection following cesarean delivery: A hospital-based case-control study. Acta Obstet Gynecol Scand 2021; 100:2167-2175. [PMID: 34309849 DOI: 10.1111/aogs.14235] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Cesarean section is the single most important risk factor for postpartum infection. Where the rest of the world shows increasing trends, the cesarean section rates are low in Norway and risk factors for infection after cesarean section may differ in high and low cesarean section settings. The goal of this study was to examine independent risk factors for surgical site infection after cesarean delivery in a setting of low cesarean section rates. MATERIAL AND METHODS We conducted a hospital-based case-control study at Haukeland University Hospital. We included women who presented to our hospital with surgical site infection after cesarean section during the years 2014-2016 (n = 75). Controls were selected at a ratio of 2:1 (n = 148). Cases and controls were compared with respect to maternal and pregnancy characteristics using uni- and multivariable logistic regression models. Main outcome measures were anticipated risk factors for surgical site infection. RESULTS The occurrence of surgical site infection was 0.4% and 5.4% after elective and emergency cesarean section, respectively. Compared to women without surgical site infection, women with surgical site infection were almost thrice more obese before pregnancy (OR 2.8, 95% CI 1.2-7.0), four times more likely to have preexisting psychiatric conditions (OR 4.4, 95% CI 1.1-17.6), and five times more likely to receive blood transfusion (OR 5.1, 95% CI 1.4-18.8). Signs of infection during labor was a marginally significant risk factor for surgical site infection (OR 2.0, 95% CI 1.0-5.4). CONCLUSIONS Emergency cesarean section was a significant risk factor for surgical site infection. Pregestational obesity, preexisting psychiatric conditions, and blood transfusion during or following delivery, were independent risk factors for surgical site infection. Signs of infection during labor was a marginally significant risk factor. Women with either of these risk factors should be carefully monitored and evaluated for signs of infection in the postpartum period.
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Affiliation(s)
- Sedina Atic Kvalvik
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Svein Rasmussen
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Elham Baghestan
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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Mekonnen AG, Mittiku YM. Surgical site infection and its association with rupture of membrane following cesarean section in Africa: a systematic review and meta-analysis of published studies. Matern Health Neonatol Perinatol 2021; 7:2. [PMID: 33388090 PMCID: PMC7777267 DOI: 10.1186/s40748-020-00122-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Surgical site infection occurs within 30 days after a surgical procedure and involves the skin, subcutaneous tissue, and soft tissue. Surgical site infection following cesarean section is a common postoperative complication and is associated with maternal morbidity and mortality in resource-limited settings. Even though the proportion of surgical site infection and some risk factors were reported by kinds of literature, varying results were stated across studies. There is also limited knowledge on the association between postpartum surgical site infection and the rupture of membrane. Hence, this systematic review and meta-analysis was designed to estimate the pooled proportion of surgical site infection and its association with rupture of membrane following cesarean section in Africa. Methods Studies published from January 01, 2000 to January 30, 2020 were searched from MEDLINE via PubMed, Scopus, Medscape, Web-science and CINAHL databases to search relevant published articles. We also performed a manual search of reference lists of key articles to retrieve additional relevant articles. Initially, 559 records were identified and 15 studies included in the analysis. The statistical analysis was performed using STATA 11. Heterogeneity between-study was explored by forest plot and inconsistency index (I2). The publication bias was checked by a funnel plot and Egger’s test. Pooled estimates of proportion and odds ratio were calculated by a random-effects model with a 95% confidence interval (CI). Results The overall pooled proportion of surgical site infection following cesarean section was 10.21% (I2 = 86.8, p < 0.000; 95% CI = 8.36, 12.06). The odds of developing surgical site infection among women who had the rupture of membrane before delivery were nearly 6 times higher than those who had not a rupture of the membrane (AOR = 5.65, 95% CI: 3.95–8.07). Conclusions The proportion of surgical site infections following the cesarean section is relatively high. Women who had rupture of the membrane before delivery were more likely to develop surgical site infections following the cesarean section. Due attention should be given to the provision of prophylactic antibiotics that can reduce surgical site infection after cesarean delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s40748-020-00122-2.
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Affiliation(s)
- Alemayehu Gonie Mekonnen
- Department of Nursing, College of Health Science, Debre Berhan University, Po. Box. 445, Debre Berhan, Ethiopia.
| | - Yohannes Moges Mittiku
- Department of Midwifery, College of Health Sciences, Debre Berhan University, Po. Box. 445, Debre Berhan, Ethiopia
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Gupta S, Manchanda V, Sachdev P, Kumar Saini R, Joy M. Study of incidence and risk factors of surgical site infections in lower segment caesarean section cases of tertiary care hospital of north India. Indian J Med Microbiol 2020; 39:1-5. [PMID: 33610238 DOI: 10.1016/j.ijmmb.2020.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine the incidence density, risk factors and common pathogens associated with surgical site infections (SSI) following lower segment caesarean section (LSCS) surgeries. METHODS In this Non-interventional prospective observational study, a total of 611 post caesarean emergency and elective cases were enrolled among the 1018 LSCS cases conducted for the period of May-August 2016. The demographic, risk factors and clinical data for appearance of signs and symptoms of SSI were recorded in a preformatted proforma. SSI's were classified as superficial, deep and organ space as per Centre for Disease Control (CDC), USA definitions. Pus specimens were processed and antimicrobial susceptibility results of the organisms were determined as standard microbiological techniques. RESULTS The SSI rate was found to be 10.3 per 100 surgeries in our study with superficial SSI (66.7%) being most common. Inappropriate pre-surgical antibiotic prophylaxis, anaemia, previous LSCS as indication of LSCS, intra-operative blood transfusion and comorbid illness like heart disease, hypothyroidism, chronic liver and kidney disease were found to be significantly associated with SSI. Predominance of gram negative isolates (55.3%) was seen in comparison to gram positive isolates (44.7%) as cause of surgical site infections. CONCLUSIONS SSIs rates observed are much higher than those observed in NHSN participating hospitals. Many of the risk factors identified are low hanging fruits and can be targeted to effectively reduce SSI rates.
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Affiliation(s)
- Shilpi Gupta
- Department of Microbiology Maulana Azad Medical College and Infection Control Division, Lok Nayak Hospital, New Delhi 110002, India.
| | - Vikas Manchanda
- Department of Microbiology Maulana Azad Medical College and Infection Control Division, Lok Nayak Hospital, New Delhi 110002, India.
| | - Poonam Sachdev
- Department of Obstetrics and Gynecology Lok Nayak Hospital, New Delhi, 110002, India.
| | - Rajesh Kumar Saini
- Infection Control Division, Lok Nayak Hospital, New Delhi 110002, India.
| | - Minimol Joy
- Infection Control Division, Lok Nayak Hospital, New Delhi 110002, India.
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Miremberg H, Barber E, Tamayev L, Ganer Herman H, Bar J, Kovo M. When is the right time to remove staples after an elective cesarean delivery?: a randomized control trial. J Matern Fetal Neonatal Med 2020; 33:4004-4009. [PMID: 30897986 DOI: 10.1080/14767058.2019.1594189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To determine if there are differences in scar healing and cosmetic outcome between early and late metal staples removal after cesarean delivery.Study design: Randomized controlled trial, in which patients undergoing a scheduled nonemergent cesarean delivery were randomly assigned to early staples removal versus late staples removal. Outcome assessors were blinded to group allocation. Scars were evaluated 8 weeks after cesarean delivery. Primary outcome measures were Patient and Observer Scar Assessment Scale (POSAS) scores. Secondary outcome measures included surgical site infection, wound disruption, hematoma, or seroma.Results: During the study period, 104 patients were randomized. There were no between-group differences in maternal demographics. Both groups had similar indications for cesarean delivery and similar rate of previous one or more cesarean delivery. Patient and Observer Scar Assessment Scale were similar for patients (p = .932) and for physician observer (p = .529). No significant differences were demonstrated between the groups in the rate of surgical site infection or wound disruption.Conclusions: Removal of stainless steel staples on postoperative 4 versus postoperative 8 after cesarean delivery showed similar outcome without significant effect on incision healing. Therefore, timing of removal staples after cesarean delivery could be performed based on patients and surgeon preference.
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Affiliation(s)
- Hadas Miremberg
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Tel Aviv, Israel
| | - Elad Barber
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Tel Aviv, Israel
| | - Liliya Tamayev
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Tel Aviv, Israel
| | - Hadas Ganer Herman
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Tel Aviv, Israel
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Poprzeczny AJ, Grivell RM, Louise J, Deussen AR, Dodd JM. Skin and subcutaneous fascia closure at caesarean section to reduce wound complications: the closure randomised trial. BMC Pregnancy Childbirth 2020; 20:606. [PMID: 33032560 PMCID: PMC7545895 DOI: 10.1186/s12884-020-03305-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/30/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Wound infection is a common complication following caesarean section. Factors influencing the risk of infection may include the suture material for skin closure, and closure of the subcutaneous fascia. We assessed the effect of skin closure with absorbable versus non-absorbable suture, and closure versus non-closure of the subcutaneous fascia on risk of wound infection following Caesarean section. METHODS Women undergoing caesarean birth at an Adelaide maternity hospital were eligible for recruitment to a randomised trial using a 2 × 2 factorial design. Women were randomised to either closure or non-closure of the subcutaneous fascia and to subcuticular skin closure with an absorbable or non-absorbable suture. Participants were randomised to each of the two interventions into one of 4 possible groups: Group 1 - non-absorbable skin suture and non-closure of the subcutaneous fascia; Group 2 - absorbable skin suture and non-closure of the subcutaneous fascia; Group 3 - non-absorbable skin suture and closure of the subcutaneous fascia; and Group 4 - absorbable skin suture and closure of the subcutaneous fascia. The primary outcomes were reported wound infection and wound haematoma or seroma within the first 30 days after birth. RESULTS A total of 851 women were recruited and randomised, with 849 women included in the analyses (Group 1: 216 women; Group 2: 212 women; Group 3: 212 women; Group 4: 211 women). In women who underwent fascia closure, there was a statistically significant increase in risk of wound infection within 30 days post-operatively for those who had skin closure with an absorbable suture (Group 4), compared with women who had skin closure with a non-absorbable suture (Group 3) (adjusted RR 2.17; 95% CI 1.05, 4.45; p = 0.035). There was no significant difference in risk of wound infection for absorbable vs non-absorbable sutures in women who did not undergo fascia closure. CONCLUSION The combination of subcutaneous fascia closure and skin closure with an absorbable suture may be associated with an increased risk of reported wound infection after caesarean section. TRIAL REGISTRATION Prospectively registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12608000143325 , on the 20th March, 2008.
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Affiliation(s)
- Amanda J Poprzeczny
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia.,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, 72 King William Road, North Adelaide, Adelaide, South Australia, 5006, Australia
| | - Rosalie M Grivell
- Flinders Medical Centre, Department of Obstetrics and Gynaecology, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jennie Louise
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia.,The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
| | - Jodie M Dodd
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia. .,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, 72 King William Road, North Adelaide, Adelaide, South Australia, 5006, Australia.
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Harzif AK, Wicaksono MD, Kallista A, Emeraldi M, Pratama G. Overview of risk factor and bacterial pattern in patient with surgical site infection after caesarean section in Ciptomangunkusumo Hospital from 2016 to 2018. Infect Prev Pract 2020; 2:100090. [PMID: 34368724 PMCID: PMC8336288 DOI: 10.1016/j.infpip.2020.100090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 09/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background Caesarean section is one of the most commonly performed surgeries both in the hospital. The incidence of infections in cesarean section varies greatly around the world at 3–15%. SSI on is a multifactorial process that starts from the perioperative preparation, the patient, the type of surgery, the type of germ and other factors. Aims To determine the characteristics of patients, bacterial patterns, and risk factors for the incidence of SSI in Cipto Mangunkusumo National General Hospital in 2016–2018. Method This study was an observational study using a retrospective cohort method. The subject of this study were patients undergoing cesarean section in Cipto Mangunkusumo National General Hospital in 2016–2018 recruited using consecutive sampling method. Based on the data obtained, bivariate and multivariate analysis were conducted to determine the factors affecting post-caesarean SSI. Results A total of 2052 subjects were included in the study. There were 85 cases of surgical site infection (SSI) out of 2052 operations (4.14 %). A total of 85 SSI cases and 1967 control groups were included in the risk factor analysis. The most common bacteria found in surgical site infection culture were Staphylococcus aureus (16,5%), Klebsiella pneumoniae (12,9%), Escherichia coli (9,4%), Enterococcus faecalis (9,4%), and others (21,2%). Variables associated with SSI in this study is fetal distress (p=0,002; AOR = 2,265 CI 95 % 1,350–3,801) and BMI ≥30 kg/m2 (p=0,028; AOR 1,824 CI 95% 1,066–3,121). Conclusion Factors influencing the incidence of SSI post cesarean section was fetal distress (p=0,002; AOR = 2,265 CI 95 % 1,350–3,801) and BMI ≥30 kg/m2 (p=0,028; AOR 1,824 CI 95% 1,066–3,121).
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Affiliation(s)
- Achmad Kemal Harzif
- Department of Obstetrics and Gynecology, Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Muhammad Dwi Wicaksono
- Department of Obstetrics and Gynecology, Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Annissa Kallista
- Department of Obstetrics and Gynecology, Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Malvin Emeraldi
- Department of Obstetrics and Gynecology, Fatmawati General Hospital, Jakarta, Indonesia
| | - Gita Pratama
- Department of Obstetrics and Gynecology, Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
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11
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Wloch C, Van Hoek AJ, Green N, Conneely J, Harrington P, Sheridan E, Wilson J, Lamagni T. Cost-benefit analysis of surveillance for surgical site infection following caesarean section. BMJ Open 2020; 10:e036919. [PMID: 32690746 PMCID: PMC7375637 DOI: 10.1136/bmjopen-2020-036919] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To estimate the economic burden to the health service of surgical site infection following caesarean section and to identify potential savings achievable through implementation of a surveillance programme. DESIGN Economic model to evaluate the costs and benefits of surveillance from community and hospital healthcare providers' perspective. SETTING England. PARTICIPANTS Women undergoing caesarean section in National Health Service hospitals. MAIN OUTCOME MEASURE Costs attributable to treatment and management of surgical site infection following caesarean section. RESULTS The costs (2010) for a hospital carrying out 800 caesarean sections a year based on infection risk of 9.6% were estimated at £18 914 (95% CI 11 521 to 29 499) with 28% accounted for by community care (£5370). With inflation to 2019 prices, this equates to an estimated cost of £5.0 m for all caesarean sections performed annually in England 2018-2019, approximately £1866 and £93 per infection managed in hospital and community, respectively. The cost of surveillance for a hospital for one calendar quarter was estimated as £3747 (2010 costs). Modelling a decrease in risk of infection of 30%, 20% or 10% between successive surveillance periods indicated that a variable intermittent surveillance strategy achieved higher or similar net savings than continuous surveillance. Breakeven was reached sooner with the variable surveillance strategy than continuous surveillance when the baseline risk of infection was 10% or 15% and smaller loses with a baseline risk of 5%. CONCLUSION Surveillance of surgical site infections after caesarean section with feedback of data to surgical teams offers a potentially effective means to reduce infection risk, improve patient experience and save money for the health service.
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Affiliation(s)
- Catherine Wloch
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Albert Jan Van Hoek
- Immunisation, Hepatitis, and Blood Safety, Public Health England, London, UK
| | - Nathan Green
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Joanna Conneely
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Pauline Harrington
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Elizabeth Sheridan
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Jennie Wilson
- Richard Wells Research Centre, University of West London, London, UK
| | - Theresa Lamagni
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
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12
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Cherian T, Hedt-Gauthier B, Nkurunziza T, Sonderman K, Gruendl MA, Nihiwacu E, Ramadhan B, Gaju E, Nahimana E, Habiyakare C, Ntakiyiruta G, Matousek A, Riviello R, Kateera F. Diagnosing Post-Cesarean Surgical Site Infections in Rural Rwanda: Development, Validation, and Field Testing of a Screening Algorithm for Use by Community Health Workers. Surg Infect (Larchmt) 2020; 21:613-620. [PMID: 32423365 DOI: 10.1089/sur.2020.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: We aimed to develop and validate a screening algorithm to assist community health workers (CHWs) in identifying surgical site infections (SSIs) after cesarean section (c-section) in rural Africa. Methods: Patients were adult women who underwent c-section at a Rwandan rural district hospital between March and October 2017. A CHW administered a nine-item clinical questionnaire 10 ± 3 days post-operatively. Independently, a general practitioner (GP) administered the same questionnaire and assessed SSI presence by physical examination. The GP's SSI diagnosis was used as the gold standard. Using a simplified Classification and Regression Tree analysis, we identified a subset of screening questions with maximum sensitivity for the GP and CHW and evaluated the subset's sensitivity and specificity in a validation dataset. Then, we compared the subset's results when implemented in the community by CHWs with health center-reported SSI. Results: Of the 596 women enrolled, 525 (88.1%) completed the clinical questionnaire. The combination of questions concerning fever, pain, and discolored drainage maximized sensitivity for both the GPs (sensitivity = 96.8%; specificity = 85.6%) and CHWs (sensitivity = 87.1%; specificity = 73.8%). In the validation dataset, this subset had sensitivity of 95.2% and specificity of 83.3% for the GP-administered questions and sensitivity of 76.2% and specificity of 81.4% for the CHW-administered questions. In the community screening, the overall percent agreement between CHW and health center diagnoses was 81.1% (95% confidence interval: 77.2%-84.6%). Conclusions: We identified a subset of questions that had good predictive features for SSI, but its sensitivity was lower when administered by CHWs in a clinical setting, and it performed poorly in the community. Methods to improve diagnostic ability, including training or telemedicine, must be explored.
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Affiliation(s)
- Teena Cherian
- Department of Global Health and Social Medicine and Harvard Medical School, Boston, Massachusetts, USA
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine and Harvard Medical School, Boston, Massachusetts, USA.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Kristin Sonderman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Magdalena Anna Gruendl
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Epidemiology, Technical University Munich, Munich, Germany
| | | | | | - Erick Gaju
- Rwanda Ministry of Health, Kigali, Rwanda
| | | | | | | | - Alexi Matousek
- Heart and Lung Institute, Sacred Heart Medical Center, Spokane, Washington, USA
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
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13
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Tuffaha HW, Aitken J, Chambers S, Scuffham PA. A Framework to Prioritise Health Research Proposals for Funding: Integrating Value for Money. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:761-770. [PMID: 31257553 DOI: 10.1007/s40258-019-00495-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
When making funding decisions, research organisations largely consider the merits (e.g. scientific rigour and feasibility) of submitted research proposals; yet, there is often little or no reference to their value for money. This may be attributed to the challenges of assessing and integrating value of research into existing research prioritisation processes. We propose a framework that considers both the merits of research and its value for money to guide health research funding decisions. A practical framework is developed based on current processes followed by funding organizations for assessing investigator-initiated research proposals, and analytical methods for evaluating the expected value of research. We apply the analytical methods to estimate the expected return on investment of two real-world grant applications. The framework comprises four sequential steps: (1) initial screening of applications for eligibility and completeness; (2) merit assessment of eligible proposals; (3) estimating the expected value of research for the shortlisted proposals that pass the first two steps and ranking of proposals based on return on investment; and (4) selecting research proposals for funding. We demonstrate how the expected value for money can be efficiently estimated using certain information provided in funding applications. The proposed framework integrates value-for-money assessment into the existing research prioritisation processes. Considering value for money to inform research funding decisions is vital to achieve efficient utilisation of research budgets and maximise returns on research investments.
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Affiliation(s)
- Haitham W Tuffaha
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
- School of Medicine, Centre for Applied Health Economics, Griffith University, Nathan, 4111, QLD, Australia.
| | - Joanne Aitken
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Cancer Council Queensland, Spring Hill, QLD, Australia
| | - Suzanne Chambers
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Cancer Council Queensland, Spring Hill, QLD, Australia
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- School of Medicine, Centre for Applied Health Economics, Griffith University, Nathan, 4111, QLD, Australia
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14
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Surgical site infection following cesarean section in a general hospital in Kuwait: trends and risk factors. Epidemiol Infect 2019; 147:e287. [PMID: 31597580 PMCID: PMC6805794 DOI: 10.1017/s0950268819001675] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Surgical site infections (SSI) are a significant cause of post-surgical morbidity and mortality. The objectives of this study were to determine the prevalence of SSI and identify risk factors for infections following cesarean section (CS). A prospective study of SSI after CS was carried out from January 2014 to December 2016 using the methodology of the American National Nosocomial Infection Surveillance System. Suspected SSIs were confirmed clinically by the surgeon, and or, by culture. Seven thousand two hundred thirty five CS were performed with an overall SSI prevalence of 2.1%, increasing from 1.7% in 2014 to 2.95% in 2016 (P = 0.010). Of 152 cases of SSI, the prevalence of infection was 46.7% in women ⩽30 years and 53.3% in women >30 years (P = 0.119). Of 148 culture samples from as many women, 112 (75.7%) yielded growth of microorganisms with 42 (37.5%) of isolates being multi-drug resistant (MDR). Women who did not receive prophylactic antibiotics (35.5%) developed SSI more often than those who did (P < 0.0001). These findings suggest that emergency CS and inappropriate antibiotic prophylaxis are risk factors for developing SSI. In the light of the emergence of MDR bacteria there is a need to implement revised prophylactic antibiotic policy as part of antimicrobial stewardship to decrease SSI rates.
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15
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Short-Term Postoperative Outcomes between 4% Icodextrin Solution and Hyaluronic Acid- Carboxymethyl Cellulose Membrane during Emergency Cesarean Section. J Clin Med 2019; 8:jcm8081249. [PMID: 31426585 PMCID: PMC6723814 DOI: 10.3390/jcm8081249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 11/21/2022] Open
Abstract
Emergency cesarean sections are associated with more postoperative complications than with elective cesarean sections. Seprafilm and Adept are commonly used adhesion reduction devices and have been applied in abdominal or pelvic surgery for a long time. This study focuses on comparing the short-term postoperative outcomes of emergency cesarean sections between two groups. We performed a retrospective study that included all patients who received emergency caesarean sections from the same surgeon at MacKay Memorial Hospital between August 2014 and November 2017, We analyzed the overall cases and conducted a subgroup analysis of cases with contaminated or dirty/infected wounds in regard to the rates of surgical-site infection (SSI), bandemia, delayed flatus passage, and length of hospital stay. The two groups were similar with respect to the rates of SSI, bandemia, and length of hospital stay. However, Seprafilm was associated with higher risk of delayed flatus passage over 48 h (OR: 2.67, 95% CI = 2.16–7.64, p = 0.001). It also needs less time for recovery of the digestive system and less medical management postoperatively. In cases of contaminated or dirty/infected wounds, Adept user also had significantly lower rates (10.3% vs. 32%, p= 0.048, OR: 4.12, CI = 1.09–15.61) of postcesarean metritis.
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16
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Saeed KB, Corcoran P, Greene RA. Incisional surgical site infection following cesarean section: A national retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2019; 240:256-260. [PMID: 31344664 DOI: 10.1016/j.ejogrb.2019.07.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the rate and associated risk factors for incisional surgical site infection following cesarean section in Ireland. STUDY DESIGN This study was a retrospective population-based cohort study, conducted using the Hospital In-Patient Enquiry database (HIPE) for the period 2005-2016. All women who underwent cesarean section between 2005 and 2016 in Ireland were included. Potential risk factors for incisional surgical site infection were selected based on the existing literature and their availability within the HIPE database. The risk of incisional surgical site infection following cesarean section with exact Poisson 95% confidence intervals were reported. Multivariable Poisson regression included all potential risk factors simultaneously. Risk ratios are reported with their 95% confidence intervals and P-values. RESULTS There were 802,182 deliveries during the study period, 219,859 of which (27.4%) were by cesarean section. There were 1396 cases of incisional surgical site infection, a risk of 0.63% (95% confidence interval: 0.60-0.67%). Public patients had approximately 20% higher risk and the risk was almost 40% higher among women aged over 35 years compared with those aged under 25 years. Most notable, related to the morbidities assessed, was the twofold increased risk of incisional surgical site infection associated with pre-existing diabetes and with urinary tract infection in pregnancy. Premature rupture of membranes, pyrexia during labour and postpartum haemorrhage each increased risk by 40-60%. Hematoma of a cesarean section wound remained by far the strongest risk factor for incisional surgical site infection. CONCLUSION Of all the risk factors we studied, hematoma had the strongest association with development of incisional surgical site infection. Of all women birthing by cesarean section in Ireland during 2005-2016, 25% had at least one of the risk factors identified by our study. Approximately 40% of the incisional surgical site infection cases came from this 25%. This might suggest that a universal approach to reducing risk of surgical site infection is warranted.
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Affiliation(s)
- Khalid Bm Saeed
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; Cork University Maternity Hospital, Wilton, Cork, Ireland.
| | - Paul Corcoran
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Richard A Greene
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; Cork University Maternity Hospital, Wilton, Cork, Ireland
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17
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Castillo E, McIsaac C, MacDougall B, Wilson D, Kohr R. Post-Caesarean Section Surgical Site Infection Surveillance Using an Online Database and Mobile Phone Technology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 39:645-651.e1. [PMID: 28729097 DOI: 10.1016/j.jogc.2016.12.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 11/16/2016] [Accepted: 12/15/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obstetric surgical site infections (SSIs) are common and expensive to the health care system but remain under reported given shorter postoperative hospital stays and suboptimal post-discharge surveillance systems. SSIs, for the purpose of this paper, are defined according to the Center for Disease Control and Prevention (1999) as infection incurring within 30 days of the operative procedure (in this case, Caesarean section [CS]). PRIMARY OBJECTIVE Demonstrate the feasibility of real-life use of a patient driven SSIs post-discharge surveillance system consisting of an online database and mobile phone technology (surgical mobile app - how2trak) among women undergoing CS in a Canadian urban centre. SECONDARY OBJECTIVE Estimate the rate of SSIs and associated predisposing factors. METHODS Prospective cohort of consecutive women delivering by CS at one urban Canadian hospital. Using surgical mobile app-how2trak-predetermined demographics, comorbidities, procedure characteristics, and self-reported symptoms and signs of infection were collected and linked to patients' incision self-portraits (photos) on postpartum days 3, 7, 10, and 30. RESULTS A total of 105 patients were enrolled over a 5-month period. Mean age was 31 years, 13% were diabetic, and most were at low risk of surgical complications. Forty-six percent of surgeries were emergency CSs, and 104/105 received antibiotic prophylaxis. Forty-five percent of patients (47/105) submitted at least one photo, and among those, one surgical site infection was detected by photo appearance and self-reported symptoms by postpartum day 10. The majority of patients whom uploaded photos did so multiple times and 43% of them submitted photos up to day 30. Patients with either a diagnosis of diabetes or self-reported Asian ethnicity were less likely to submit photos. CONCLUSIONS Post-discharge surveillance for CS-related SSIs using surgical mobile app how2trak is feasible and deserves further study in the post-discharge setting.
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Affiliation(s)
- Eliana Castillo
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB; Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, AB.
| | - Corrine McIsaac
- Department of Nursing, University of Dalhousie, Halifax, NS; Health Outcomes Worldwide, Founder & CEO, New Waterford, NS; Health Outcomes Worldwide, New Waterford, NS
| | | | - Douglas Wilson
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, AB
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18
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Abdelraheim AR, Gomaa K, Ibrahim EM, Mohammed MM, Khalifa EM, Youssef AM, Abdelhakeem AK, Hassan H, Alghany AA, El Gelany S. Intra-abdominal infection (IAI) following cesarean section: a retrospective study in a tertiary referral hospital in Egypt. BMC Pregnancy Childbirth 2019; 19:234. [PMID: 31286872 PMCID: PMC6615272 DOI: 10.1186/s12884-019-2394-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/30/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The incidence of post cesarean intra-abdominal infection (IAI) and the independent risk factors associated with it were retrospectively studied at a tertiary referral hospital in Egypt. METHODS The study targeted the period between January 2014 and December 2017 (4 years) at Minia University Hospital for Obstetrics and Gynecology (a tertiary referral hospital), Minia Governorate, Egypt. All cases that developed IAI following cesarean section (CS) during the study period were included (408 cases, which served as the case group); in addition, 1300 cases that underwent CS during the study period and were not complicated by IAI or surgical site Infection (SSI) were randomly chosen from the records (control group). The records of cases and controls were compared and bivariate analysis and multivariate logistic regression were used to identify risk factors for IAI. RESULTS During the studied period, there were 35,500 deliveries in the hospital, and 14200 cases (40%) of these were by cesarean section, producing a rate of 40%. The incidence of IAI post CS was 2.87%, and the mortality rate was 1.2% (due to septicemia). The most identifiable risk factors for IAI were chorioamnionitis (AOR 9.54; 95% CI =6.15-16.2; p ≤ 0.001) and premature rupture of membranes (PROM) (AOR 7.54; 95% CI =5.69-10.24; p ≤ 0.001). Risk factors also included: prolonged duration of CS > 1 h (AOR 3.42; 95% CI =2.45-5.23; p = 0.005), no antenatal care (ANC) visits (AOR 3.14; 95% CI =2.14-4.26; p = 0.003), blood loss > 1000 ml (AOR 2.86; 95% CI =2.04-3.92; p = 0.011), emergency CS (AOR 2.24; 95% CI =1.78-3.29; p = 0.016), prolonged labor ≥24 h. (AOR 1.76; 95% CI =1.26-2.27; p = 0.034) and diabetes mellitus (AOR 1.68; 95% CI =1.11-2.39; p = 0.021). CONCLUSIONS The incidence of IAI post CS in our hospital was 2.87%. Identification of predictors and risk factors for IAI is an important preventive measure.
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Affiliation(s)
- Ahmed R Abdelraheim
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt.
| | - Khaled Gomaa
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Emad M Ibrahim
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mo'men M Mohammed
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Eissa M Khalifa
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ayman M Youssef
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed K Abdelhakeem
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Heba Hassan
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed Abd Alghany
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Saad El Gelany
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
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19
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Nkurunziza T, Kateera F, Sonderman K, Gruendl M, Nihiwacu E, Ramadhan B, Cherian T, Nahimana E, Ntakiyiruta G, Habiyakare C, Ngamije P, Matousek A, Gaju E, Riviello R, Hedt-Gauthier B. Prevalence and predictors of surgical-site infection after caesarean section at a rural district hospital in Rwanda. Br J Surg 2019; 106:e121-e128. [PMID: 30620071 PMCID: PMC7938824 DOI: 10.1002/bjs.11060] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/30/2018] [Accepted: 10/30/2018] [Indexed: 11/26/2022]
Abstract
Background There are few prospective studies of outcomes following surgery in rural district hospitals in sub-Saharan Africa. This study aimed to estimate the prevalence and predictors of surgical-site infection (SSI) following caesarean section at Kirehe District Hospital in rural Rwanda. Methods Adult women who underwent caesarean section between March and October 2017 were given a voucher to return to the hospital on postoperative day (POD) 10 (±3 days). At the visit, a physician evaluated the patient for an SSI. A multivariable logistic regression model was used to identify risk factors for SSI, built using backward stepwise selection. Results Of 729 women who had a caesarean section, 620 were eligible for follow-up, of whom 550 (88·7 per cent) returned for assessment. The prevalence of SSI on POD 10 was 10·9 per cent (60 women). In the multivariable analysis, the following factors were significantly associated with SSI: bodyweight more than 75 kg (odds ratio (OR) 5·98, 1·56 to 22·96; P = 0·009); spending more than €1·1 on travel to the health centre (OR 2·42, 1·31 to 4·49; P = 0·005); being a housewife compared with a farmer (OR 2·93, 1·08 to 7·97; P = 0·035); and skin preparation with a single antiseptic compared with a combination of two antiseptics (OR 4·42, 1·05 to 18·57; P = 0·043). Receiving either preoperative or postoperative antibiotics was not associated with SSI. Conclusion The prevalence of SSI after caesarean section is consistent with rates reported at tertiary facilities in sub-Saharan Africa. Combining antiseptic solutions for skin preparation could reduce the risk of SSI.
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Affiliation(s)
| | - F Kateera
- Partners In Health/Inshuti Mu Buzima, Rwanda
| | - K Sonderman
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Centre for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - M Gruendl
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Public Health, Technical University Munich, Munich, Germany
| | - E Nihiwacu
- Partners In Health/Inshuti Mu Buzima, Rwanda
| | - B Ramadhan
- Partners In Health/Inshuti Mu Buzima, Rwanda
| | - T Cherian
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - E Nahimana
- Partners In Health/Inshuti Mu Buzima, Rwanda
| | | | | | | | - A Matousek
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Centre for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - E Gaju
- Ministry of Health Kigali, Rwanda
| | - R Riviello
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Centre for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - B Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Harris BS, Hopkins MK, Villers MS, Weber JM, Pieper C, Grotegut CA, Swamy GK, Hughes BL, Heine RP. Efficacy of Non-Beta-lactam Antibiotics for Prevention of Cesarean Delivery Surgical Site Infections. AJP Rep 2019; 9:e167-e171. [PMID: 31044099 PMCID: PMC6491367 DOI: 10.1055/s-0039-1685503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 03/08/2019] [Indexed: 11/03/2022] Open
Abstract
Objective To examine the association between perioperative Beta ( β ))-lactam versus non- β -lactam antibiotics and cesarean delivery surgical site infection (SSI). Study Design Retrospective cohort of women undergoing cesarean delivery from January 1 to December 31, 2014. All women undergoing cesarean after 34 weeks with a postpartum visit were included. Prevalence of SSI was compared between women receiving β -lactam versus non- β -lactam antibiotics. Bivariate analyses were performed using Pearson's Chi-square, Fisher's exact, or Wilcoxon's rank-sum tests. Logistic regression models were fit controlling for possible confounders. Results Of the 929 women included, 826 (89%) received β -lactam prophylaxis and 103 (11%) received a non- β -lactam. Among the 893 women who reported a non-type I (low risk) allergy, 819 (92%) received β -lactam prophylaxis. SSI occurred in 7% of women who received β -lactam antibiotics versus 15% of women who received a non- β -lactam ( p = 0.004). β -Lactam prophylaxis was associated with lower odds of SSI compared with non- β -lactam antibiotics (odds ratio [OR] = 0.43; 95% confidence interval [CI] = 0.22-0.83; p = 0.01) after controlling for chorioamnionitis in labor, postlabor cesarean, endometritis, tobacco use, and body mass index (BMI). Conclusion β -Lactam perioperative prophylaxis is associated with lower odds of a cesarean delivery surgical site infection compared with non- β -lactam antibiotics.
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Affiliation(s)
- Benjamin S Harris
- Department of Obstetrics and Gynecology, Duke University Health System, Durham, North Carolina
| | - Maeve K Hopkins
- Department of Obstetrics and Gynecology, Duke University Health System, Durham, North Carolina
| | - Margaret S Villers
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Health System, Durham, North Carolina
| | - Jeremy M Weber
- Department of Biostatistics and Bioinformatics, Duke University Health System, Durham, North Carolina
| | - Carl Pieper
- Department of Biostatistics and Bioinformatics, Duke University Health System, Durham, North Carolina
| | - Chad A Grotegut
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Health System, Durham, North Carolina
| | - Geeta K Swamy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Health System, Durham, North Carolina
| | - Brenna L Hughes
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Health System, Durham, North Carolina
| | - R Phillips Heine
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Health System, Durham, North Carolina
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Merzougui L, Marwen N, Hannachi H, Asma M, Ben Elhaj O, Waddah M, Fatnassi R. [Incidence and risk factors of surgical site infection following caesarean section in a Tunisian maternity unit]. SANTE PUBLIQUE 2019; 30:339-347. [PMID: 30541263 DOI: 10.3917/spub.183.0339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Surgical site infection (SSI) is a major health concern and is one of the most common complications following caesarean section, with an incidence of 3%-15%. With the worldwide increase in caesarean section rates, the incidence of SSI is expected to increase in parallel. This study was designed to estimate the incidence and determine the risk factors of SSI after caesarean section in an Obstetrics and Gynaecology department in the Kairouan region in Tunisia. METHODS A prospective cohort study of all patients who delivered by caesarean section between December 2015 and February 2016 was conducted in the Kairouan Obstetrics and Gynaecology department. The clinical status of these women was monitored during the 30-day postoperative period (in the outpatients department, emergency room or they were contacted by phone). A multivariate logistic regression model was used to identify risk factors. RESULTS Of the 714 patients admitted for caesarean delivery, 636 (89%) were monitored for 30 days. Thirty-two of these women were diagnosed with SSI, corresponding to an incidence of 5% (95% CI = 3.3%; 6.6%). 87.5% (n = 28) of SSI were superficial and 12.5% (n = 4) were complex (deep and organ/space). Multivariate logistic regression analysis identified the woman's age as a risk factor of SSI (RR = 1.07 for every year increment, 95% CI = 1.007; 1.17), whereas drainage was identified as a protective factor (RR = 0.16, 95% CI = 0.05; 0.48). CONCLUSION This study identified the incidence and risk factors of postoperative infection following caesarean section. Prevention of these infections should be a public health priority.
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Risk factors for surgical site infection after cesarean delivery: A case-control study. Am J Infect Control 2019; 47:164-169. [PMID: 30253904 DOI: 10.1016/j.ajic.2018.07.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/28/2018] [Accepted: 07/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The cesarean delivery (CD) rate is increasing worldwide. Surgical site infection (SSI) incidence is likely to follow an upward trajectory. We examined the incidence and risk factors for SSI after CD. METHODS A case-control study of women who had a lower-segment CD during the study period was performed at Ireland's Cork University Maternity Hospital. Cases were patients who presented to the hospital with SSI and who met the criteria of the U.S. Centers for Disease Control and Prevention. Controls were randomly selected from the discharge register of CDs at a ratio of 2:1. Data were extracted from the medical records. A multivariable stepwise logistic regression model approach was used, and the results were expressed as adjusted odds ratios (aORs). RESULTS The SSI rate was 2%. The greatest contribution to risk of SSI was associated with maternal obesity (aOR, 4.76; 95% confidence interval [CI], 2.00-11.32) and hypertensive disorders (aOR, 6.67; 95% CI, 1.54-28.99]. There was also an increased risk for women who underwent an emergency CD (aOR, 3.50; 95% CI, 1.09-11.30), for women who had ≥5 vaginal examinations (aOR, 3.24; 95% CI, 0.92-11.41), and for women without hypertensive disorders who delivered a baby weighing <3,500 g (aOR, 2.18; 95% CI, 1.08-4.37). CONCLUSIONS Obesity, hypertensive disorders, emergency CD, and multiple vaginal examinations were independent risk factors for SSI after CD.
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Heinemann N, Solnica A, Abdelkader R, Gutman J, Nalbandian N, Raizman E, Hochner-Celnikier D. Timing of staples and dressing removal after cesarean delivery (the SCARR study). Int J Gynaecol Obstet 2018; 144:283-289. [PMID: 30582610 DOI: 10.1002/ijgo.12757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 09/25/2018] [Accepted: 12/21/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate optimal timing of dressing and staples removal after cesarean delivery (CD). METHODS This prospective clustered clinical trial enrolled women undergoing CD between January 1, 2013, and October 31, 2014, at Hadassah-Hebrew University Hospital, Jerusalem. Women were assigned to one of five clusters differing in timing of dressing and staples removal. We assessed scar healing at 6 weeks. RESULTS 920 women completed telephone questionnaires. Wound healing did not differ significantly among the clusters: the healing complication rate was 21% in the control group (n=46) and ranged from 18% to 26% (n=27-50) in clusters two to five (P=0.49). More healing complications were observed in women with a body mass index (BMI) of more than 35 kg/m2 versus 35 kg/m2 or less (P=0.016), urgent versus elective CD (P=0.013), preterm premature rupture of the membranes (PPROM) versus intact membranes (P=0.016), and chorioamnionitis at delivery versus no chorioamnionitis (P=0.001). 586 (64%) women underwent physician assessment at staples removal and at 6 weeks post CD. CONCLUSIONS Timing of dressing and staples removal has no effect on CD scar healing in low- and high-risk parturients. A BMI of more than 35 kg/m2 , urgent CD, PPROM, and chorioamnionitis were associated with mal-healing, regardless of cluster. Clinicaltrials.gov: NCT01724255.
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Affiliation(s)
- Netanella Heinemann
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amy Solnica
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Rana Abdelkader
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jakov Gutman
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Noemzar Nalbandian
- Department of Nursing Administration, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ela Raizman
- Department of Nursing Administration, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Drorith Hochner-Celnikier
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Scharner D, Gittel C, Winter K, Blaue D, Schedlbauer C, Vervuert I, Brehm W. Comparison of incisional complications between skin closures using a simple continuous or intradermal pattern: a pilot study in horses undergoing ventral median celiotomy. PeerJ 2018; 6:e5772. [PMID: 30430040 PMCID: PMC6231425 DOI: 10.7717/peerj.5772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/17/2018] [Indexed: 11/28/2022] Open
Abstract
Background Development of incisional complications following ventral median celiotomy might depend on suture pattern for skin closure. Methods In this prospective study, 21 healthy male horses underwent celiotomy. Skin closure was either performed via a continuous percutaneous pattern (CO group; 5 warmbloods/5 ponies) or an intradermal pattern (ID group; 5 warmbloods/6 ponies). Follow-up examination of the incisional site included daily monitoring for edema, dehiscence, and drainage. Transcutaneous ultrasound was performed at Days 3, 6, and 10 as well as on Week 8 and 12 to evaluate size of edema and presence or absence of sinus formation, and hernia formation. Prevalence of incisional infection on base of positive microbiological analysis at any time up to Day 10 was evaluated and compared between ID and CO group. Furthermore, edema size was analysed by a linear mixed-effect model for group and time dependency. Results Observed incisional complications included edema (9/10 in CO, 10/11 in ID), suture sinus formation (2/10 in CO, 1/11 in ID), surgical site infection (2/10 in CO, 0/11 in ID), and incisional hernia (1/10 in CO, 0/11 in ID). The overall prevalence of incisional infection was 9.5% without significant differences between both groups (20% in CO, 0% in ID; p = 0.214). Edema size was not dependent on time or group (p = 0.545 and p = 0.627, respectively). Discussion CO and ID suture pattern are appropriate for skin closure following ventral median celiotomy in horses. None of the animals in the continuous ID group developed surgical site infections, even without the use of antibiotics.
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Affiliation(s)
- Doreen Scharner
- Department for Horses, University of Leipzig, Leipzig, Germany
| | - Claudia Gittel
- Department for Horses, University of Leipzig, Leipzig, Germany
| | - Karsten Winter
- Institute of Anatomy, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Dominique Blaue
- Institute of Animal Nutrition, Nutrition Diseases and Dietetics, University of Leipzig, Leipzig, Germany
| | - Carola Schedlbauer
- Institute of Animal Nutrition, Nutrition Diseases and Dietetics, University of Leipzig, Leipzig, Germany
| | - Ingrid Vervuert
- Institute of Animal Nutrition, Nutrition Diseases and Dietetics, University of Leipzig, Leipzig, Germany
| | - Walter Brehm
- Department for Horses, University of Leipzig, Leipzig, Germany
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Tomita K, Chiba N, Ochiai S, Yokozuka K, Gunji T, Hikita K, Ozawa Y, Okihara M, Sano T, Tsutsui R, Shimazu M, Kawachi S. Superficial Surgical Site Infection in Hepatobiliary-Pancreatic Surgery: Subcuticular Suture Versus Skin Staples. J Gastrointest Surg 2018; 22:1385-1393. [PMID: 29633116 DOI: 10.1007/s11605-018-3754-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/20/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE Postoperative superficial surgical site infection is a major complication in hepatobiliary-pancreatic surgery. We aimed to compare the efficacy of subcuticular sutures versus staples for skin closure in preventing superficial surgical site infection in hepatobiliary-pancreatic surgery. METHODS Consecutive patients who underwent hepatobiliary-pancreatic surgery at our hospital from October 2006 to March 2011 and from April 2012 to March 2015 were reviewed retrospectively. Superficial surgical site infection incidence was evaluated in patients who received subcuticular sutures and those who received staples for skin closure. Propensity score matching analysis was used to adjust bias from confounding factors. RESULTS A total of 691 patients were included. Patients with skin staple closures (n = 346) were compared with patients with subcuticular suture closures (n = 345). After a propensity score matching analysis, a significant difference in superficial surgical site infection incidence was found between the skin stapler group (11.3%) and subcuticular sutures group (2.6%). The same comparison was performed by a subgroup analysis and supported this finding in patients after hepatectomy without biliary reconstruction, pancreatoduodenectomy, or open laparotomy surgeries and in patients with body mass index < 25. CONCLUSIONS Subcuticular suturing after hepatobiliary-pancreatic surgery was more efficacious in reducing postoperative superficial surgical site infection incidence than staples for skin closure.
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Affiliation(s)
- Koichi Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan.
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Shigeto Ochiai
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Kei Yokozuka
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Takahiro Gunji
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Kosuke Hikita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Yosuke Ozawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Masaaki Okihara
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Toru Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Rina Tsutsui
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Motohide Shimazu
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
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Wodajo S, Belayneh M, Gebremedhin S. Magnitude and Factors Associated With Post-Cesarean Surgical Site Infection at Hawassa University Teaching and Referral Hospital, Southern Ethiopia: A Cross-sectional Study. Ethiop J Health Sci 2018; 27:283-290. [PMID: 29217927 PMCID: PMC5614999 DOI: 10.4314/ejhs.v27i3.10] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Surgical site infection (SSI) after cesarean section (CS) increases maternal morbidity, hospital stay and medical cost. However, in Ethiopia, limited evidence exists regarding the magnitude and risk factors of post-CS wound infection. The purpose of this study was to determine the prevalence of - and factors associated with the problem among mothers who gave birth in Hawassa University Teaching and Referral Hospital, Southern Ethiopia. Methods Hospital based cross-sectional study was conducted based on the medical records of 592 women who underwent CS from June 2012 to May 2013. Data on the occurrence and factors associated with SSIs were extracted. Factors associated with SSI were identified using multivariate logistic regression analysis. The output of the analysis is presented using adjusted odds ratio (OR) with the corresponding 95% confidence interval (CI). Results The prevalence of SSI was 11.0% (95% CI: 8.6–13.8%). Mothers with prolonged labor (6.78, 95% CI: 2.54–18.00) and prolonged rupture of membrane (5.83, 95% CI: 2.14–15.89) had significantly increased odds of SSI. Compared to mothers who had no digital vaginal examination, those who had 1–4 and 5 or more examinations were at higher risk with OR of 2.91 (95% CI: 1.21–6.99) and 8.59 (95% CI: 1.74–42.23), respectively. Prolonged duration of surgery (12.32, 95% CI: 5.46–27.77), wound contamination class III (9.61, 95% CI: 1.84–50.06) and postoperative anemia (2.62, 95% CI: 1.21–5.69) were also significant predictors. CS conducted by junior practitioners is likely to be followed by infection. Conclusion Post-CS SSI is relatively common in the hospital. Thus, it should be averted by implementing infection prevention techniques.
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Affiliation(s)
- Samuel Wodajo
- Assosa Zonal Hospital, Benshangul Gumuz Region, Assosa, Ethiopia
| | - Mehretu Belayneh
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
| | - Samson Gebremedhin
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
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Aslan Çetin B, Aydogan Mathyk B, Barut S, Koroglu N, Zindar Y, Konal M, Atis Aydin A. The impact of subcutaneous irrigation on wound complications after cesarean sections: A prospective randomised study. Eur J Obstet Gynecol Reprod Biol 2018; 227:67-70. [PMID: 29894926 DOI: 10.1016/j.ejogrb.2018.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the effectiveness of subcutaneous saline irrigation in preventing wound complications after cesarean sections. STUDY DESIGN Patients undergoing primary cesarean sections were randomly assigned to either the subcutaneous saline irrigation group or the control group. The participants were asked to come to the hospital for routine inspection of the skin incision on day 7 and day 30 postoperatively. The wounds were inspected for hematoma, seroma, separation and signs of superficial infection. The prime outcome was the comparison of the superficial surgical site infection (SSI) rates among the groups. Additionally, factors associated with wound complications were also analyzed using logistic regression. RESULTS A total of 204 women undergoing primary cesarean sections were randomized, and 185 were included in the final analysis. There was no significant difference in terms of SSI rates among the groups (14.3% in the saline group vs 12.8% in the control group, p = 0.76). However, the existences of hematoma and seroma were significantly lower in the saline irrigation group compared to the control group. CONCLUSION Irrigation of subcutaneous tissue decreases the occurrences of both postoperative hematoma and seroma in women undergoing primary cesarean sections.
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Affiliation(s)
- Berna Aslan Çetin
- Kanuni Sultan Suleyman Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Begum Aydogan Mathyk
- University of North Carolina, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Chapel Hill, NC, USA.
| | - Sibel Barut
- Kanuni Sultan Suleyman Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Nadiye Koroglu
- Kanuni Sultan Suleyman Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Yelda Zindar
- Okmeydani Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Merve Konal
- Sarkoy State Hospital, Department of Obstetrics and Gynecology, Tekirdag, Turkey
| | - Alev Atis Aydin
- Kanuni Sultan Suleyman Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
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Freed JS, Ko J. An Innovative Advance in Non-invasive Wound Closure: A New Paradigm. Mil Med 2018; 183:472-480. [DOI: 10.1093/milmed/usx165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jeffrey S Freed
- Colon and Rectal Surgery, James J. Peters VA Medical Center, Bronx, New York and Department of Surgery, Icahn School of Medicine at Mount Sinai
| | - John Ko
- Plastic Surgery, James J. Peters VA Medical Center, Bronx, New York and Department of Surgery, Icahn School of Medicine at Mount Sinai
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Jasim HH, Sulaiman SAS, Khan AH, Dawood OT, Abdulameer AH, Usha R. Incidence and Risk Factors of Surgical Site Infection Among Patients Undergoing Cesarean Section. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1179559x17725273] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hanan Hussein Jasim
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Omar Thanoon Dawood
- Department of Medical Services, Ministry of Science and Technology, Baghdad, Iraq
| | - Aseel Hadi Abdulameer
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - R Usha
- Department of Anesthesia and Pain Management, Hospital Pulau Pinang, Penang, Malaysia
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Ketcheson F, Woolcott C, Allen V, Langley JM. Risk factors for surgical site infection following cesarean delivery: a retrospective cohort study. CMAJ Open 2017; 5:E546-E556. [PMID: 28698181 PMCID: PMC5621950 DOI: 10.9778/cmajo.20160164] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The rate of cesarean delivery is increasing in North America. Surgical site infection following this operation can make it difficult to recover, care for a baby and return home. We aimed to determine the incidence of surgical site infection to 30 days following cesarean delivery, associated risk factors and whether risk factors differed for predischarge versus postdischarge infection. METHODS We identified a retrospective cohort in Nova Scotia by linking the provincial perinatal database to hospital admissions and physician billings databases to follow women for 30 days after they had given birth by cesarean delivery between Jan. 1, 1997 and Dec. 31, 2012. Logistic regression with generalized estimating equations was used to determine risk factors for infection. RESULTS A total of 25 123 women had 33 991 cesarean deliveries over the study period. Of the 25 123, 923 had surgical site infections, giving an incidence rate of 2.7% (95% CI 2.54%-2.89%); the incidence decreased over time. Risk factors for infection (adjusted odds ratios ≥ 1.5) were prepregnancy weight 87.0 kg or more, gaining 30.0 kg or more during pregnancy, chorioamnionitis, maternal blood transfusion, anticoagulation therapy, alcohol or drug abuse, second stage of labour before surgery, delivery in 1997-2000 and delivery in a hospital performing 130-1249 cesarean deliveries annually. Women who gave birth earlier in the study period, those who gave birth in a hospital with 130-949 cesarean deliveries per year and those with more than 1 fetus were at a significantly higher risk for surgical site infection before discharge; women who smoked were at significantly higher risk for surgical site infection after discharge. INTERPRETATION Most risk factors are known before delivery, and some are potentially modifiable. Although the incidence of surgical site infection decreased over time, targeted clinical and infection prevention and control interventions could further reduce the burden of illness associated with this health-care-related infection.
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Affiliation(s)
- Felicia Ketcheson
- Affiliations: Department of Community Health and Epidemiology (Ketcheson, Allen, Langley); Department of Pediatrics (Woolcott, Langley); Department of Obstetrics and Gynaecology (Woolcott, Allen), Dalhousie University; Canadian Centre for Vaccinology (Allen, Langley), IWK Health Centre, Halifax, NS
| | - Christy Woolcott
- Affiliations: Department of Community Health and Epidemiology (Ketcheson, Allen, Langley); Department of Pediatrics (Woolcott, Langley); Department of Obstetrics and Gynaecology (Woolcott, Allen), Dalhousie University; Canadian Centre for Vaccinology (Allen, Langley), IWK Health Centre, Halifax, NS
| | - Victoria Allen
- Affiliations: Department of Community Health and Epidemiology (Ketcheson, Allen, Langley); Department of Pediatrics (Woolcott, Langley); Department of Obstetrics and Gynaecology (Woolcott, Allen), Dalhousie University; Canadian Centre for Vaccinology (Allen, Langley), IWK Health Centre, Halifax, NS
| | - Joanne M Langley
- Affiliations: Department of Community Health and Epidemiology (Ketcheson, Allen, Langley); Department of Pediatrics (Woolcott, Langley); Department of Obstetrics and Gynaecology (Woolcott, Allen), Dalhousie University; Canadian Centre for Vaccinology (Allen, Langley), IWK Health Centre, Halifax, NS
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Scharner D, Winter K, Brehm W, Kämpfert M, Gittel C. Incisional complications following ventral median coeliotomy in horses. Does suturing of the peritoneum reduce the risk? Tierarztl Prax Ausg G Grosstiere Nutztiere 2017; 45:24-32. [PMID: 27831593 DOI: 10.15653/tpg-160536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/08/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Despite advances in surgical technique in abdominal surgery, incisional complications are frequently reported following ventral midline laparotomy in horses. The aim of this study was to determine the incidence of incisional complications at our clinic and to identify possible risk factors. Furthermore, we investigated whether suturing the peritoneum leads to a reduction of incisional complications. MATERIAL AND METHODS In this retrospective study, records of patients of the Large Animal Clinic for Surgery of the University of Leipzig from January 2010 to December 2015 were analysed. Horses with ventral midline laparotomy following colic were included in the study. Evaluated parameters comprised breed, sex, age of the horse, localisation of the colic disease, invasiveness of the surgical intervention, duration of general anaesthesia, suture pattern of the laparotomy wound and postoperative fever or leukopenia. Incisional complications included suture dehiscence, exudation from the wound and incisional hernia formation. Wound oedema formation was evaluated separately. RESULTS Incisional complications in the form of exudation and suture dehiscence occurred in 8.9% (18/202) of the horses. Postoperative hernia formation was observed in 5.2% (9/173) of patients. Breed, sex, localisation of the colic disease, invasiveness of the surgical intervention, duration of general anaesthesia and postoperative leukopenia did not influence the frequency of incisional complications. An increased risk of incisional complications was found in horses aged 20 years and older (odds ratio [OR] 17.90), in animals with postoperative fever (OR 7.48) and in horses with unsutured peritoneum (OR 7.68). Furthermore, patients with moderate and severe wound oedema displayed a significantly increased risk for the development of incisional complications. CONCLUSION AND CLINICAL RELEVANCE Suture pattern is the only risk factor that can be directly influenced by the surgeon. Because a peritoneal suture is associated with a decreased risk of incisional complications, it should be standard practice when closing a laparotomy wound in the horse.
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Affiliation(s)
- Doreen Scharner
- PD Dr. Doreen Scharner, Chirurgische Tierklinik, Veterinärmedizinische Fakultät der Universität Leipzig, An den Tierkliniken 21, 04103 Leipzig, E-Mail:
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Tierney N, LaCoursiere DY, Hebert S, Kelly TF, Lukacz ES. Incidence of wound complications after cesarean delivery: is suture closure better? J Matern Fetal Neonatal Med 2016; 30:1992-1996. [DOI: 10.1080/14767058.2016.1236080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nicole Tierney
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - D. Yvette LaCoursiere
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Steven Hebert
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Thomas F. Kelly
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Emily S. Lukacz
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, CA, USA
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Early wound dressing removal after scheduled cesarean delivery: a randomized controlled trial. Am J Obstet Gynecol 2016; 215:388.e1-5. [PMID: 27018465 DOI: 10.1016/j.ajog.2016.03.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/17/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Following cesarean delivery, wound dressings are typically left over the incision for 24-48 hours. OBJECTIVE The objective of this study was to determine if early removal of the wound dressing at 6 hours postsurgery has any effect on wound complications. STUDY DESIGN This was a randomized, controlled study from August 2013 through January 2015 in which 320 low-risk women aged 18-44 years having scheduled primary, first repeat, or second repeat cesarean delivery were randomized for wound dressing removal at either 6 or 24 hours postsurgery. Skin closure was with staples in all cases. The primary outcome was postoperative wound complications, defined as infection, disruption (skin dehiscence or deeper), or seroma/hematoma. Also examined was patient satisfaction with timing of their ability to wash or shower after wound dressing removal. A sample size of 160 women in each group was needed to show a 100% increase in the wound complication incidence from 12-24%. RESULTS A total of 320 women were randomized, 160 in the 6-hour group and 160 in the 24-hour group. The proportion of primary and repeat cesarean deliveries was similar. The incidence of wound complications was not significantly different between the groups, 13.8% in the 6-hour group and 12.5% in the 24-hour group (odds ratio, 1.16; 95% confidence interval, 0.58-2.14). More women were pleased and satisfied with their ability to wash or shower soon after wound dressing removal in the 6-hour group (75.6%) compared to the 24-hour group (56.9%; odds ratio, 2.35; 95% confidence interval, 1.46-3.79). CONCLUSION Early removal of the wound dressing at 6 hours following cesarean delivery has no detrimental effect on incision healing. Early removal permits the woman to attend to personal hygiene earlier, making her more satisfied with her postoperative recovery.
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Gastmeier P. Postdischarge Surveillance for Surgical Site Infection: The Continuing Challenge. Infect Control Hosp Epidemiol 2016; 27:1287-90. [PMID: 17152024 DOI: 10.1086/509000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Accepted: 09/09/2006] [Indexed: 12/30/2022]
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[What's the optimal time of cesarean section antibiotic prophylaxis, before skin incision or after umbilical cord clamping? A prospective randomized study]. ACTA ACUST UNITED AC 2016; 45:1133-1143. [PMID: 27212612 DOI: 10.1016/j.jgyn.2016.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/26/2016] [Accepted: 03/10/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To compare the effect of antibiotics prophylaxis within 30 mins before skin incision (A) and after umbilical cord clamping (C) on the incidence of postoperative infections in patients undergoing elective caesarean section at Farhat Hached university teaching hospital. MATERIALS AND METHODS We conducted a randomised clinical trial evaluating 279 patients undergoing elective caesarean section. Patients were randomly assigned a group number that allocated them to either arm of the study. They received the same prophylactic antibiotic (cefazol® 2g) according to their allotment. They were followed up to detect infection up to 30 days postoperatively. The primary outcome was postoperative infection. The data collected were analysed with SPSS version 18.0 using univariate and bivariate analysis. RESULTS The risk of overall postoperative infection was not significantly lower when prophylaxis was given before skin incision (4.37 % (A) vs 9.85 % (C); P=0.07; OR=0.42 [0.15-1.12]). We also found wound infections to be significantly reduced in the pre-incision group (2.2 % [A] vs 8.45 % [C]; P=0.03; OR=0.24 [0.06-0.88]). However, there was no difference in the endometritis infectious. On the other hand, there was no negative impact on the neonatal features. CONCLUSIONS Giving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of wound infections.
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Halwani MA, Turnbull AE, Harris M, Witter F, Perl TM. Postdischarge surveillance for infection following cesarean section: A prospective cohort study comparing methodologies. Am J Infect Control 2016; 44:455-7. [PMID: 26706153 DOI: 10.1016/j.ajic.2015.10.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/16/2015] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess how enhanced postdischarge telephone follow-up calls would improve case finding for surgical site infection (SSI) surveillance after cesarean section. METHODS We conducted a prospective cohort study of all patients who delivered by cesarean section between April 22 and August 22, 2010. In addition to our routine surveillance, using clinical databases and electronic patient records, we also made follow-up calls to the patients at 7, 14, and 30 days postoperation. A standard questionnaire with questions about symptoms of SSI, health-seeking behaviors, and treatment received was administered. Descriptive statistics and univariate analysis were performed to assess the effect of the enhanced surveillance. RESULTS One hundred ninety-three patients underwent cesarean section during this study period. Standard surveillance identified 14 infections with telephone follow-ups identifying an additional 5 infections. Using the call as a gold standard, the sensitivity of the standard methodology to capture SSI was 73.3%. The duration of the calls ranged from 1 to 5 minutes and were well received by the patients. CONCLUSIONS Results suggest that follow-up telephone calls to patients following cesarean section identifies 26.3% of the total SSIs. Enhanced surveillance can provide more informed data to enhance performance and avoid underestimation of rates.
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Affiliation(s)
| | - Alison E Turnbull
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Frank Witter
- Department of Obstetrics and Gynecology, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Trish M Perl
- Department of Medicine, Division of Infectious Diseases, Department of Pathology, and Department of Epidemiology, Johns Hopkins University, Baltimore, MD
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SHREE R, Park SY, Beigi RH, Dunn SL, Krans EE. Surgical Site Infection following Cesarean Delivery: Patient, Provider, and Procedure-Specific Risk Factors. Am J Perinatol 2016; 33:157-64. [PMID: 26344010 PMCID: PMC5064434 DOI: 10.1055/s-0035-1563548] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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. CONCLUSION Multiple patient, provider, and procedure-specific risk factors contribute to CD SSI risk which may be targeted in infection-control efforts.
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Affiliation(s)
- Raj SHREE
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213, (412) 641-6085, Fax (412) 641-3170
| | - Seo Young Park
- Department of Medicine, Center for Research on Health Care, University of Pittsburgh, 200 Meyran Avenue, Pittsburgh, PA 15213, (412) 864-3022, Fax (412) 586-9672
| | - Richard H. Beigi
- Department of Obstetrics, Gynecology and RS, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, (412) 641- 4220, Fax (412) 641-1133
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213, (412) 641-6085, Fax (412) 641-3170
| | - Shannon L. Dunn
- Department of Obstetrics, Gynecology and RS, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, (412) 641- 4220, Fax (412) 641-1133
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213, (412) 641-6085, Fax (412) 641-3170
| | - Elizabeth E. Krans
- Department of Obstetrics, Gynecology and RS, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, (412) 641- 4220, Fax (412) 641-1133
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213, (412) 641-6085, Fax (412) 641-3170
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Cesarean section surgical site infections in sub-Saharan Africa: a multi-country study from Medecins Sans Frontieres. World J Surg 2015; 39:350-5. [PMID: 25358418 PMCID: PMC4300431 DOI: 10.1007/s00268-014-2840-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Surgical site infections (SSI) are a significant cause of post-surgical morbidity and mortality and can be an indicator of surgical quality. The objectives of this study were to measure post-operative SSI after cesarean section (CS) at four sites in three sub-Saharan African countries and to describe the associated risk factors in order to improved quality of care in low and middle income surgical programs. Methods This study included data from four emergency obstetric programs supported by Medecins sans Frontieres, from Burundi, the Democratic Republic of Congo (DRC), and Sierra Leone. Women undergoing from August 1 2010 to January 31 2011 were included. CS post-operative SSI data were prospectively collected. Logistic regression was used to model SSI risk factors. Findings In total, 1,276 women underwent CS. The incidence of SSI was 7.3 % (range 1.7–10.4 %). 93 % of SSI were superficial. The median length of stay of women without SSI was 7 days (range 3–63 days) compared to 21 days (range 5–51 days) in those with SSI (p < 0.001). In multivariate analysis, younger age, premature rupture of the membranes, and neonatal death were associated with an increased risk of SSI, while antenatal hemorrhage and the Lubutu, DRC project site were associated with a lower risk of developing an SSI. Conclusions This study demonstrates that surgery can be performed with a low incidence of SSI, a proxy for surgical safety, in sub-Saharan Africa. Protocols such as perioperative antibiotics and basic infrastructure such as clean water and sterilization can be achieved. Simple data collection tools will assist policymakers with monitoring and evaluation as well as quality control assurance of surgical programs in low and middle income countries.
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Ng W, Brown A, Alexander D, Ho MF, Kerr B, Amato M, Katz K. A multifaceted prevention program to reduce infection after cesarean section: Interventions assessed using an intensive postdischarge surveillance system. Am J Infect Control 2015; 43:805-9. [PMID: 25957817 DOI: 10.1016/j.ajic.2015.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND We assessed the effects of the components of a multifaceted and evidence-based caesarean-section surgical site infection (SSI) prevention program on the SSI rate after cesarean section using a postdischarge surveillance (PDS) system. METHODS Multiple prevention interventions were serially implemented. SSI case finding was undertaken through active inpatient surveillance and intensive PDS using a standardized form at the 6-week postdischarge visit. SSI diagnosis was made using the Centers for Disease Control and Prevention standardized criteria. All cesarean deliveries between July 2007 and December 2012 were included. Changes in SSI rate were analyzed using segmented regression analysis. RESULTS Nine thousand four hundred forty-two cesarean sections were assessed during the study period. PDS forms were completed for 7,985 women (85%). SSI was detected in 451 cases (5.6%): 91% were superficial, 9% were deep/organ-space infections. The SSI rate decreased incrementally from 8.2% at baseline to 4.1%; significant decreases were observed after optimizing antibiotic prophylaxis timing, using a surgical safety checklist, and enhancing prenatal education to discourage prehospital self-removal of hair. Nonelective surgeries or those undertaken after >12 hours of rupture of membranes had a significantly higher rate compared with those without either risk factor (6.3% vs 3.2%; P < .001). CONCLUSIONS A multifaceted SSI prevention strategy, with periodic feedback of data, led to a significant reduction in SSI rates after cesarean section.
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Affiliation(s)
- Wil Ng
- North York General Hospital, Toronto, Ontario, Canada.
| | - Adrian Brown
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Man Fan Ho
- North York General Hospital, Toronto, Ontario, Canada
| | - Bonnie Kerr
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
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Tuffaha HW, Gillespie BM, Chaboyer W, Gordon LG, Scuffham PA. Cost-utility analysis of negative pressure wound therapy in high-risk cesarean section wounds. J Surg Res 2015; 195:612-22. [DOI: 10.1016/j.jss.2015.02.008] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/14/2015] [Accepted: 02/06/2015] [Indexed: 11/16/2022]
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Jensen KK, Henriksen NA, Jorgensen LN. Abdominal wall hernia and pregnancy: a systematic review. Hernia 2015; 19:689-96. [PMID: 25862027 DOI: 10.1007/s10029-015-1373-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 03/29/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE There is no consensus as to the treatment strategy for abdominal wall hernias in fertile women. This study was undertaken to review the current literature on treatment of abdominal wall hernias in fertile women before or during pregnancy. METHODS A literature search was undertaken in PubMed and Embase in combination with a cross-reference search of eligible papers. RESULTS We included 31 papers of which 23 were case reports. In fertile women undergoing sutured or mesh repair, pain was described in a few patients during the last trimester of a subsequent pregnancy. Emergency surgery of incarcerated hernias in pregnant women, as well as combined hernia repair and cesarean section appears as safe procedures. No major complications were reported following hernia repair before or during pregnancy. The combined procedure of elective cesarean section and abdominal wall hernia repair was reported in 102 patients without major complications. CONCLUSIONS The literature on abdominal wall hernia and pregnancy is sparse. Abdominal wall hernia repair with suture or mesh may cause pain in the last trimester of a subsequent pregnancy. Hernia repair in conjunction with cesarean section appear as the optimal treatment of a pregnant patient with a symptomatic abdominal wall hernia.
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Affiliation(s)
- K K Jensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
| | - N A Henriksen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark
| | - L N Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark
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Kobayashi S, Ito M, Yamamoto S, Kinugasa Y, Kotake M, Saida Y, Kobatake T, Yamanaka T, Saito N, Moriya Y. Randomized clinical trial of skin closure by subcuticular suture or skin stapling after elective colorectal cancer surgery. Br J Surg 2015; 102:495-500. [DOI: 10.1002/bjs.9786] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 12/18/2014] [Accepted: 01/16/2015] [Indexed: 12/22/2022]
Abstract
Abstract
Background
The best suture method to prevent incisional surgical-site infection (SSI) after clean-contaminated surgery has not been clarified.
Methods
Patients undergoing elective colorectal cancer surgery at one of 16 centres were randomized to receive either subcuticular sutures or skin stapling for skin closure. The primary endpoint was the rate of incisional SSI. Secondary endpoints of interest included time required for wound closure, incidence of wound problems, postoperative length of stay, wound aesthetics and patient satisfaction.
Results
A total of 1264 patients were enrolled. The cumulative incidence of incisional SSI by day 30 after surgery was similar after subcuticular sutures and stapled closure (8·7 versus 9·8 per cent respectively; P = 0·576). Comparison of cumulative incidence curves revealed that SSI occurred later in the subcuticular suture group (P = 0·019) (hazard ratio 0·66, 95 per cent c.i. 0·45 to 0·97). Wound problems (P = 0·484), wound aesthetics (P = 0·182) and postoperative duration of hospital stay (P = 0·510) did not differ between the groups; subcuticular sutures took 5 min longer than staples (P < 0·001). Patients in the subcuticular suture group were significantly more satisfied with their wound (52·4 per cent versus 42·7 per cent in the staple group; P = 0·002).
Conclusion
Compared with skin stapling, subcuticular sutures did not reduce the risk of incisional SSI after colorectal surgery. Registration number: UMIN000004001 (http://www.umin.ac.jp/ctr).
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Affiliation(s)
- S Kobayashi
- Department of Colorectal Surgery, National Cancer Centre Hospital East, Kashiwa, Japan
- Department of Surgery, Toho University Ohashi Medical Centre, Tokyo, Japan
- Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - M Ito
- Department of Colorectal Surgery, National Cancer Centre Hospital East, Kashiwa, Japan
| | - S Yamamoto
- Department of Colorectal Surgery, National Cancer Centre Hospital, Tokyo, Japan
| | - Y Kinugasa
- Department of Colon and Rectal Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - M Kotake
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Y Saida
- Department of Surgery, Toho University Ohashi Medical Centre, Tokyo, Japan
| | - T Kobatake
- Department of Gastroenterological Surgery, National Hospital Organization Shikoku Cancer Centre, Matsuyama, Japan
| | - T Yamanaka
- Department of Biostatistics, Yokohama City University, Yokohama, Japan
| | - N Saito
- Department of Colorectal Surgery, National Cancer Centre Hospital East, Kashiwa, Japan
| | - Y Moriya
- Department of Colorectal Surgery, National Cancer Centre Hospital, Tokyo, Japan
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Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk Factors for Surgical Site Infection After Low Transverse Cesarean Section. Infect Control Hosp Epidemiol 2015; 29:477-84; discussion 485-6. [DOI: 10.1086/587810] [Citation(s) in RCA: 189] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background.Independent risk factors for surgical site infection (SSI) after cesarean section have not been well documented, despite the large number of cesarean sections performed and the relatively common occurrence of SSI.Objective.To determine independent risk factors for SSI after low transverse cesarean section.Design.Retrospective case-control study.Setting.Barnes-Jewish Hospital, a 1,250-bed tertiary care hospital.Patients.A total of 1,605 women who underwent low transverse cesarean section during the period from July 1999 to June 2001.Methods.Using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for SSI or wound complication and/or data on antibiotic use during the surgical hospitalization or at readmission to the hospital or emergency department, we identified potential cases of SSI in a cohort of patients who underwent a low transverse cesarean section. Cases of SSI were verified by chart review using the definitions from the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System. Control patients without SSI or endomyometritis were randomly selected from the population of patients who underwent cesarean section. Independent risk factors for SSI were determined by logistic regression.Results.SSIs were identified in 81 (5.0%) of 1,605 women who underwent low transverse cesarean section. Independent risk factors for SSI included development of subcutaneous hematoma after the procedure (adjusted odds ratio [aOR], 11.6 [95% confidence interval {CI}, 4.1–33.2]), operation performed by the university teaching service (aOR, 2.7 [95% CI, 1.4–5.2]), and a higher body mass index at admission (aOR, 1.1 [95% CI, 1.0–1.1]). Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI (aOR, 0.2 [95% CI, 0.1–0.5]). Use of staples for skin closure was associated with a marginally increased risk of SSI.Conclusions.These independent risk factors should be incorporated into approaches for the prevention and surveillance of SSI after surgery.
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Vincent A, Ayzac L, Girard R, Caillat-Vallet E, Chapuis C, Depaix F, Dumas AM, Gignoux C, Haond C, Lafarge-Leboucher J, Launay C, Tissot-Guerraz F, Fabry J. Downward Trends in Surgical Site and Urinary Tract Infections After Cesarean Delivery in a French Surveillance Network, 1997–2003. Infect Control Hosp Epidemiol 2015; 29:227-33. [DOI: 10.1086/527512] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To evaluate whether the adjusted rates of surgical site infection (SSI) and urinary tract infection (UTI) after cesarean delivery decrease in maternity units that perform active healthcare-associated infection surveillance.Design.Trend analysis by means of multiple logistic regression.Setting.A total of 80 maternity units participating in the Mater Sud-Est surveillance network.Patients.A total of 37,074 cesarean deliveries were included in the surveillance from January 1, 1997, through December 31, 2003.Methods.We used a logistic regression model to estimate risk-adjusted post–cesarean delivery infection odds ratios. The variables included were the maternity units' annual rate of operative procedures, the level of dispensed neonatal care, the year of delivery, maternal risk factors, and the characteristics of cesarean delivery. The trend of risk-adjusted odds ratios for SSI and UTI during the study period was studied by linear regression.Results.The crude rates of SSI and UTI after cesarean delivery were 1.5% (571 of 37,074 patients) and 1.8% (685 of 37,074 patients), respectively. During the study period, the decrease in SSI and UTI adjusted odds ratios was statistically significant (R = −0.823 [P = .023] and R = −0.906 [P = .005], respectively).Conclusion.Reductions of 48% in the SSI rate and 52% in the UTI rate were observed in the maternity units. These unbiased trends could be related to progress in preventive practices as a result of the increased dissemination of national standards and a collaborative surveillance with benchmarking of rates.
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Cheng K, Li J, Kong Q, Wang C, Ye N, Xia G. Risk factors for surgical site infection in a teaching hospital: a prospective study of 1,138 patients. Patient Prefer Adherence 2015; 9:1171-7. [PMID: 26316722 PMCID: PMC4542557 DOI: 10.2147/ppa.s86153] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify risk factors for surgical site infection (SSI) in a teaching hospital. METHODS A prospective study was initiated to investigate risk factors for SSI at a university-affiliated tertiary care center from July 2013 to December 2014. The chi-square test for categorical variables was used to determine the significance of association, whereas the multivariate logistic regression model was used to examine independent risk factors for SSI. RESULTS A total of 1,138 patients met the inclusion criteria, in whom 36 cases of infection occurred during the hospitalization period and two cases occurred after discharge. Univariate analysis showed that SSI was associated with the type of operation, wound classification, volume of blood loss, blood transfusion, American Society of Anesthesiology score before surgery, risk index, duration of surgery, diabetes, cancer, gastrointestinal catheter, urinary catheter, postoperative drainage, and preprocedural white blood cell count. Multivariate analysis identified six independent parameters correlating with the occurrence of SSI: diabetes (odds ratio [OR] 6.400; 95% confidence interval [CI] 2.582-15.866; P=0.000); cancer (OR 2.427; 95% CI 1.028-5.732; P=0.043); preprocedural white blood cell count more than 10×10(9)/L (OR 6.988; CI 3.165-15.425; P=0.000); wound classification (clean contaminated [OR: 7.893; CI: 2.244-27.762; P=0.001]; contaminated [OR: 7.031; CI: 1.652-29.922; P=0.008]; dirty [OR: 48.778; CI: 5.418-439.164; P=0.001]); operative duration more than 120 minutes (OR 4.289; CI 1.773-10.378; P=0.001); and postoperative drainage (OR 3.957; CI 1.422-11.008; P=0.008). CONCLUSION Our data suggest that all these risk factors could be regarded as potential indicators of SSI and that relevant preventive measures should be taken to reduce SSI and improve patient outcomes.
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Affiliation(s)
- Keping Cheng
- Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
- Correspondence: Keping Cheng, Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Gulou district of Nanjing 210009, People’s Republic of China, Tel +86 25 8327 2069, Email
| | - Jiawei Li
- Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Qingfang Kong
- Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Changxian Wang
- Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Nanyuan Ye
- Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Guohua Xia
- Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
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Plotting dermal sutures: an easy dermal suture technique. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e108. [PMID: 25289302 PMCID: PMC4173828 DOI: 10.1097/gox.0000000000000052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The epidemiology of infections in the puerperium (post partum period) is not well understood and remains underestimated because surveillance systems are often limited to the acute care setting. The most common source of persistent fever after delivery is genital tract infection for which diagnosis remains mostly clinical and antibiotic treatment empiric. This review will emphasize surgical site infections (SSIs) and endometritis. Septic thrombo-phlebitis, mastitis, urinary tract infections and rare infections will be covered in less detail. Puerperal sepsis will not be reviewed.
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Affiliation(s)
- E Dalton
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada
| | - E Castillo
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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Use of electrocautery for coagulation and wound complications in Caesarean sections. ScientificWorldJournal 2014; 2014:602375. [PMID: 25143985 PMCID: PMC4131101 DOI: 10.1155/2014/602375] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 07/04/2014] [Indexed: 12/05/2022] Open
Abstract
Objective. To evaluate the safety of electrocautery for coagulation during Caesarean sections. Study Design. A randomized, controlled, clinical pilot study was performed at a university maternity hospital. After admission for delivery and decision to perform a C-section, volunteers were randomized to either the intervention group (use of electrocautery for coagulation) or nonintervention group. The women were examined at the time of postpartum discharge (day 3), at days 7 to 10, and again at days 30 to 40 for signs of infection, hematoma, seroma, or dehiscence. Data were analyzed using an intention-to-treat analysis, and risk ratios were calculated. Results. No significant differences were found between the two groups. Only 2.8% of patients in the intervention group developed surgical wound complications during hospitalization. However, 7 to 10 days following discharge, these rates reached 23.0% and 15.4% in the intervention and nonintervention groups, respectively (RR = 1.50, 95% CI = 0.84–2.60). Conclusion. Further studies should confirm whether the use of electrocautery for coagulation does not increase the risk of surgical wound complications in patients undergoing Caesarean sections.
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Morisaki N, Ganchimeg T, Ota E, Vogel JP, Souza JP, Mori R, Gülmezoglu AM. Maternal and institutional characteristics associated with the administration of prophylactic antibiotics for caesarean section: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014; 121 Suppl 1:66-75. [PMID: 24641537 DOI: 10.1111/1471-0528.12632] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To illustrate the variability in the use of antibiotic prophylaxis for caesarean section, and its effect on the prevention of postoperative infections. DESIGN Secondary analysis of a cross-sectional study. SETTING Twenty-nine countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. POPULATION Three hundred and fifty-nine health facilities with the capacity to perform caesarean section. METHODS Descriptive analysis and effect estimates using multilevel logistic regression. MAIN OUTCOME MEASURES Coverage of antibiotic prophylaxis for caesarean section. RESULTS A total of 89 121 caesarean sections were performed in 332 of the 359 facilities included in the survey; 87% under prophylactic antibiotic coverage. Thirty five facilities provided 0-49% coverage and 77 facilities provided 50-89% coverage. Institutional coverage of prophylactic antibiotics varied greatly within most countries, and was related to guideline use and the practice of clinical audits, but not to the size, location of the institution or development index of the country. Mothers with complications, such as HIV infection, anaemia, or pre-eclampsia/eclampsia, were more likely to receive antibiotic prophylaxis. At the same time, mothers undergoing caesarean birth prior to labour and those with indication for scheduled deliveries were also more likely to receive antibiotic prophylaxis, despite their lower risk of infection, compared with mothers undergoing emergency caesarean section. CONCLUSIONS Coverage of antibiotic prophylaxis for caesarean birth may be related to the perception of the importance of guidelines and clinical audits in the facility. There may also be a tendency to use antibiotics when caesarean section has been scheduled and antibiotic prophylaxis is already included in the routine clinical protocol. This study may act as a signal to re-evaluate institutional practices as a way to identify areas where improvement is possible.
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Affiliation(s)
- N Morisaki
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan; Department of Paediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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