Ketcheson Felicia, Woolcott Christy, Allen Victoria, Langley Joanne M
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.
CMAJ Open. 2017 Jul 11;5(3):E546-E556. doi: 10.9778/cmajo.20160164.
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.
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.
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.
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.
北美剖宫产率正在上升。该手术后手术部位感染会使康复、照顾婴儿及回家变得困难。我们旨在确定剖宫产术后30天内手术部位感染的发生率、相关危险因素以及出院前感染与出院后感染的危险因素是否存在差异。
我们通过将省级围产期数据库与医院入院和医生计费数据库相链接，在新斯科舍省确定了一个回顾性队列，以跟踪1997年1月1日至2012年12月31日期间剖宫产分娩的妇女30天。使用广义估计方程的逻辑回归来确定感染的危险因素。
在研究期间，共有25123名妇女进行了33991次剖宫产。在这25123名妇女中，923人发生了手术部位感染，发病率为2.7%（95%可信区间2.54%-2.89%）；发病率随时间下降。感染的危险因素（调整比值比≥1.5）包括孕前体重87.0千克或更高、孕期增重30.0千克或更多、绒毛膜羊膜炎、产妇输血、抗凝治疗、酗酒或药物滥用、手术前第二产程、1997 - 2000年分娩以及在每年进行130 - 1249例剖宫产的医院分娩。在研究期间较早分娩的妇女、在每年进行130 - 949例剖宫产的医院分娩的妇女以及多胎妊娠妇女出院前手术部位感染风险显著更高；吸烟的妇女出院后手术部位感染风险显著更高。
大多数危险因素在分娩前已知，且有些是潜在可改变的。尽管手术部位感染的发病率随时间下降，但有针对性的临床及感染预防与控制干预措施可进一步减轻与这种医疗相关感染相关的疾病负担。
