Surgical Site Infection following Cesarean Delivery: Patient, Provider, and Procedure-Specific Risk Factors

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Abstract
Objective This study aims to identify risk factors for cesarean delivery (CD) surgical site infection (SSI). Study Design Retrospective analysis of 2,739 CDs performed at the University of Pittsburgh in 2011. CD SSIs were defined using National Healthcare Safety Network (NHSN) criteria. Chi-square test and t-test were used for bivariate analyses and multivariate logistic regression was used to identify SSI risk factors. Results Of 2,739 CDs, 178 (6.5%) were complicated by SSI. Patients with a SSI were more likely to have Medicaid, have resident physicians perform the CD, an American Society of Anesthesiologists (ASA) class of ≥ 3, chorioamnionitis, tobacco use, and labor before CD. In multivariable analysis, labor (odds ratio [OR], 2.35; 95% confidence interval [95% CI], 1.65–3.38), chorioamnionitis (OR, 2.24; 95% CI, 1.25–3.83), resident teaching service (OR, 2.15; 95% CI, 1.54–3.00), tobacco use (OR, 1.70; 95% CI, 1.04–2.70), ASA class ≥ 3 (OR, 1.61; 95% CI, 1.06–2.39), and CDs performed for nonreassuring fetal status (OR, 0.43; 95% CI, 0.26–0.67) were significantly associated with CD SSI. Conclusion Multiple patient, provider, and procedure-specific risk factors contribute to CD SSI risk which may be targeted in infection-control efforts. * Dr. Shree's current affiliation is Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Washington Medical Center, WA.

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