Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; Cork University Maternity Hospital, Wilton, Cork, Ireland.
National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.
Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:256-260. doi: 10.1016/j.ejogrb.2019.07.020. Epub 2019 Jul 17.
To determine the rate and associated risk factors for incisional surgical site infection following cesarean section in Ireland.
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.
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.
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.
确定爱尔兰剖宫产术后切口手术部位感染的发生率及相关危险因素。
本研究为回顾性基于人群的队列研究，使用 2005-2016 年期间的医院住院病人查询数据库（HIPE）进行。纳入 2005-2016 年期间在爱尔兰行剖宫产术的所有女性。根据现有文献和 HIPE 数据库中的资料，选择切口手术部位感染的潜在危险因素。报道了剖宫产术后切口手术部位感染的风险，确切的泊松 95%置信区间。多变量泊松回归分析同时纳入所有潜在危险因素。报道风险比及其 95%置信区间和 P 值。
研究期间共有 802182 例分娩，其中 219859 例（27.4%）为剖宫产。发生切口手术部位感染 1396 例，发生率为 0.63%（95%置信区间：0.60-0.67%）。公共患者的风险增加约 20%，35 岁以上妇女的风险比 25 岁以下妇女高近 40%。最值得注意的是，与评估的合并症相关，与既往糖尿病和妊娠期间尿路感染相关的切口手术部位感染风险增加两倍。胎膜早破、分娩期间发热和产后出血的风险分别增加 40-60%。剖宫产切口血肿仍然是切口手术部位感染的最强危险因素。
在我们研究的所有危险因素中，血肿与切口手术部位感染的发生关系最密切。在 2005-2016 年期间在爱尔兰分娩的所有剖宫产妇女中，25%有本研究确定的至少一个危险因素。约 40%的切口手术部位感染病例来自这 25%。这可能表明，有必要采取普遍的方法来降低手术部位感染的风险。
