Islam Nazmul, Thalib Lukman, Mahmood Sadia, Varol Sameed Akif, Adel Ibrahim, Aqel Abdelrahman, Atashbari Fatemeh, Cinar Ozer
Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey.
Intensive Crit Care Nurs. 2025 Jan 28;89:103951. doi: 10.1016/j.iccn.2025.103951.
Surgical site infections (SSIs) are the most common postoperative complications after cesarean section (CS), with increased mortality, prolonged hospital stays, and increased healthcare costs.
To systematically estimate the global incidence and identify the risk factors associated with SSI, focusing on the variation between high- and low-income countries.
Observational studies reporting on the incidence of SSI after CS were systematically searched in PubMed, Embase and SCOPUS.
Multiple authors independently screened, extracted the data, and assessed therisk of bias. The primary outcome was the incidence of SSI within 30 days. Subgroup and sensitivity analyses and meta-regression examined SSI-related heterogeneity.
49 cohort studies with 271,954 participants met the inclusion criteria. We found with moderate certainty that the overall SSI incidence in CS patients was 7.0 % (95 % CI: 6.0 %-8.0 %). The SSI incidence in LMICs was 8.0 % (95 % CI: 6.0 %-10.0 %) with moderate certainty, while the incidence in HICs was 5.0 % (95 % CI: 4.0 %-7.0 %) with low certainty. Subgroup analysis indicated a significantly higher incidence in Africa and the Western Pacific. Meta-regression showed a significant decrease in SSI incidence in HICs. Maternal factors, procedural aspects, and care quality were associated with SSI.
Our findings offer valuable insights into the global incidence of SSIs following CS and provide a reliable estimate for benchmarking and quality improvement. This study adds to the evidence on SSI determinants and highlights the need for targeted preventative measures across various regional and healthcare settings.
Higher SSI rates in LMICs call for targeted infection prevention strategies, including improved preoperative preparation, antibiotic prophylaxis, and enhanced antenatal care services. In HICs, addressing lifestyle factors, managing comorbidities, and refining surgical protocols can further mitigate risks, emphasizing the need for region-specific, evidence-based interventions.
手术部位感染（SSIs）是剖宫产（CS）术后最常见的并发症，会增加死亡率、延长住院时间并增加医疗成本。
系统评估全球发病率并确定与手术部位感染相关的风险因素，重点关注高收入国家和低收入国家之间的差异。
在PubMed、Embase和SCOPUS中系统检索关于剖宫产术后手术部位感染发病率的观察性研究。
多位作者独立筛选、提取数据并评估偏倚风险。主要结局是30天内手术部位感染的发病率。亚组分析、敏感性分析和Meta回归分析了与手术部位感染相关的异质性。
49项队列研究，共271,954名参与者符合纳入标准。我们有中等把握确定剖宫产患者的总体手术部位感染发病率为7.0%（95%CI：6.0%-8.0%）。低收入和中等收入国家（LMICs）的手术部位感染发病率有中等把握为8.0%（95%CI：6.0%-10.0%），而高收入国家（HICs）的发病率有低把握为5.0%（95%CI：4.0%-7.0%）。亚组分析表明非洲和西太平洋地区的发病率显著更高。Meta回归分析显示高收入国家的手术部位感染发病率显著降低。产妇因素、手术操作方面和护理质量与手术部位感染有关。
我们的研究结果为剖宫产术后手术部位感染的全球发病率提供了有价值的见解，并为基准设定和质量改进提供了可靠的估计。本研究补充了关于手术部位感染决定因素的证据，并强调了在不同区域和医疗环境中采取针对性预防措施的必要性。
低收入和中等收入国家较高的手术部位感染率需要有针对性的感染预防策略，包括改善术前准备、抗生素预防和加强产前护理服务。在高收入国家，解决生活方式因素、管理合并症和完善手术方案可以进一步降低风险，强调需要采取针对特定区域、基于证据的干预措施。
