Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
Department of Surgery, Loma Linda University Medical Center, 1884 Gould Street, Loma Linda, CA, 92354, USA.
World J Surg. 2022 Feb;46(2):303-309. doi: 10.1007/s00268-021-06338-3. Epub 2021 Nov 19.
Maternal sepsis accounts for significant morbidity and mortality in lower income countries, and caesarean delivery, while often necessary, augments the risk of maternal sepsis. The aim of this study was to investigate the effect of Safe Surgery 2020 surgical safety checklist (SSC) implementation on post-caesarean sepsis in Tanzania.
We conducted a study in 20 facilities in Tanzania's Lake Zone as part of the Safe Surgery 2020 intervention. We prospectively collected data on SSC adherence and maternal sepsis outcomes from 1341 caesarian deliveries. The primary outcome measure was maternal sepsis rate. The primary predictor was SSC adherence. Multivariable logistic regression was used to estimate independent associations between SSC adherence and maternal sepsis.
Higher SSC adherence was associated with lower rates of maternal sepsis (<25% adherence: 5.0%; >75% adherence: 0.7%). Wound class and facility type were significantly associated with development of maternal sepsis (Wound class: Clean-Contaminated 3.7%, Contaminated/Dirty 20%, P = 0.018) (Facility Type: Health Centre 5.9%, District Hospital 4.5%, Regional Referral Hospital 1.7%, P = 0.018). In multivariable analysis, after controlling for wound class and facility type, higher SSC adherence was associated with lower rates of maternal sepsis, with an adjusted odds ratio of 0.17 per percentage point increase in SSC adherence (95% CI: 0.04, 0.79; P = 0.024).
Adherence to the SSC may reduce maternal morbidity during caesarean delivery, reinforcing the assumption that surgical quality interventions improve maternal outcomes. Future studies should continue to explore additional synergies between surgical and maternal quality improvement.
在中低收入国家，产妇脓毒症导致了大量的发病率和死亡率，而剖宫产虽然常常是必要的，但会增加产妇脓毒症的风险。本研究旨在调查 2020 年安全手术安全检查表（SSC）实施对坦桑尼亚剖宫产术后脓毒症的影响。
我们在坦桑尼亚湖地区的 20 个设施中进行了一项研究，作为 2020 年安全手术干预的一部分。我们前瞻性地收集了 1341 例剖宫产手术中 SSC 依从性和产妇脓毒症结局的数据。主要结局指标是产妇脓毒症发生率。主要预测因素是 SSC 依从性。多变量逻辑回归用于估计 SSC 依从性与产妇脓毒症之间的独立关联。
更高的 SSC 依从性与较低的产妇脓毒症发生率相关（<25%的依从性：5.0%；>75%的依从性：0.7%）。伤口分类和医疗机构类型与产妇脓毒症的发生显著相关（伤口分类：清洁污染 3.7%，污染/脏污 20%，P=0.018）（医疗机构类型：卫生中心 5.9%，地区医院 4.5%，区域转诊医院 1.7%，P=0.018）。在多变量分析中，在控制了伤口分类和医疗机构类型后，更高的 SSC 依从性与产妇脓毒症发生率较低相关，SSC 依从性每增加一个百分点，调整后的比值比为 0.17（95%CI：0.04，0.79；P=0.024）。
SSC 的依从性可能会降低剖宫产术中产妇的发病率，这进一步证明了手术质量干预措施可以改善产妇的结局。未来的研究应继续探索手术和产妇质量改进之间的其他协同作用。
