PREDICTORS OF SURGICAL SITE INFECTION AMONG WOMEN FOLLOWING CESAREAN DELIVERY: A HOSPITAL-BASED CASE–CONTROL STUDY

Problem statement
Cesarean section is the single most important risk factor for postpartum infection.
Surgical site infection (SSI) is one of the commonest complications following cesarean section (CS) with a reported incidence of 3–20%. SSI causes massive burdens on both the mother and the health care system. Moreover, it is associated with high maternal morbidity and mortality rate of up to 3%.
This study aims to determine the incidence and predictors of SSI following CS.

Methods
We conducted a hospital-based case-control study at a secondary-level hospital, during the period from January 2022 to December 2022. A total of 435 cesarean sections were performed during the studied period, of these, 11 cases developed SSI following CS. Controls were selected at a ratio of 3:1 (n = 35).
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 1,85% and 2,75% 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 3,2, 95% CI 0,6-15,0).
Parity, tobacco use, preexisting diabetes mellitus (DM), gestational DM, preeclampsia, hypertension, rupture of the membrane before operation, surgery duration, type of CS (elective or emergent), blood loss of > 1000 ml and hemoglobin less than 11 g/dl were not significantly associated with SSI.

Conclusion
Pregestational obesity was independent risk factor for surgical site infection. This finding may inform pre-operative counseling and shared decision making regarding planned elective caesarean section for women with pre-pregnancy BMI ≥ 30kg/m2.