Surgical site infection after cesarean delivery: incidence and risk factors at a US academic institution

Purpose: To identify the rate of surgical site infection (SSI) after Cesarean delivery (CD) and determine risk factors predictive for infection at a large academic institution.Methods: This was a retrospective cohort study in women undergoing CD during 2013. SSIs were defined by Centers for Disease Control (CDC) criteria. Chi square and t-tests were used for bivariate analysis and multivariate logistic regression was used to identify SSI risk factors.Results: In 2419 patients, the rate of SSI was 5.5% (n=133) with cellulitis in 4.9% (n=118), deep incisional infection in 0.6% (n=15) and intra-abdominal infection in 0.3% (n=7). On multivariate analysis, SSI was higher among CD for labor arrest (OR 2.4; 95%CI 1.6-3.5; p<.001). Preterm labor (OR 2.8; 95%CI 1.3-6.0; p=.01) and general anesthesia (OR 4.4; 95%CI 2.0-9.8; p=.003) were predictive for SSI. Increasing BMI (OR 1.1; 95%CI 1.05-1.09; p=.02), asthma (OR 1.9; 95%CI 1.1-3.2; p=.02) and smoking (OR 1.9; 95%CI 1.1-3.2; p=.02) were associated with increased SSI.Conclusions: Several patient and surgical variables are associated with increased rate of SSI after CD. Identification of risk factors for SSI after CD is important for targeted implementation of quality improvement measures and infection control interventions.