Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Obstetric and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Israel.
Surgery. 2021 Oct;170(4):1120-1124. doi: 10.1016/j.surg.2021.03.048. Epub 2021 Apr 29.
Cesarean sections are the most common surgery worldwide, and post-cesarean section infections and hemorrhage are a major cause for morbidity and mortality. In recent years, many surgeons use adhesion barriers as well as hemostatic agents during primary and repeated cesarean section. The data regarding the safety of these agents is relatively limited. The objective of this study was to investigate whether the use of adhesion barriers and topical hemostatic agents pose a risk for post-cesarean section infections.
A case-control study composed of women who were admitted to the Soroka University Medical Center between the years 2012 and 2016 was conducted. The study group was composed of women admitted owing to post-cesarean section infections (cases) and those who underwent cesarean sections without post-cesarean section infection (control subjects). Matching was done according to date and surgery setting (elective versus emergency). A univariate analysis was followed by a multiple regression model in order to examine the association between adhesion barriers/hemostatic agents and post-cesarean section infections.
During the study period, 113 patients developed postoperative infection (cases); 71.7% were diagnosed with surgical site infection, 7.1% with endometritis, and 21.2% with other infections. These were compared with 226 control subjects. In the univariate analysis, the use of adhesion barriers/hemostatic agents were found to be associated with post-cesarean section infection. Using a multivariable analysis controlling for previous cesarean section, skin closer technique, preterm delivery, and duration of surgery >60 minutes, the use of adhesion barriers as well as hemostatic agents was found to be independently associated with post-cesarean section infection (adjusted odds ratio = 2.11, 95% confidence interval = 1.17-3.84; adjusted odds ratio = 2.29, 95% confidence interval = 1.37-3.8, respectively) CONCLUSION: Adhesion barriers and hemostatic agents were found to be independently associated with post-cesarean section infections. Further larger studies are needed to reinforce our findings. The use of these materials should be carefully considered, and their cost-effectiveness re-examined.
剖宫产术是全球最常见的手术，剖宫产术后感染和出血是发病率和死亡率的主要原因。近年来，许多外科医生在初次和再次剖宫产术中使用粘连屏障和止血剂。关于这些药物安全性的数据相对有限。本研究的目的是调查粘连屏障和局部止血剂是否会增加剖宫产术后感染的风险。
对 2012 年至 2016 年期间在索罗卡大学医学中心住院的妇女进行病例对照研究。研究组由因剖宫产术后感染（病例）和未发生剖宫产术后感染（对照组）而住院的妇女组成。根据日期和手术环境（择期与急诊）进行匹配。然后进行单变量分析，接着进行多元回归模型，以检查粘连屏障/止血剂与剖宫产术后感染之间的关联。
在研究期间，113 例患者发生术后感染（病例）；71.7%诊断为手术部位感染，7.1%为子宫内膜炎，21.2%为其他感染。将这些与 226 例对照进行比较。单变量分析发现，使用粘连屏障/止血剂与剖宫产术后感染有关。使用多变量分析控制先前剖宫产、皮肤闭合技术、早产和手术时间>60 分钟后，使用粘连屏障和止血剂与剖宫产术后感染独立相关（调整后的优势比=2.11，95%置信区间=1.17-3.84；调整后的优势比=2.29，95%置信区间=1.37-3.8，分别）。
粘连屏障和止血剂与剖宫产术后感染独立相关。需要进一步进行更大规模的研究来加强我们的发现。应谨慎考虑使用这些材料，并重新检查其成本效益。
