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Predictors of surgical site skin infection and clinical outcome at caesarean section in the very severely obese: A retrospective cohort study.
- Source :
-
PloS one [PLoS One] 2019 Jun 27; Vol. 14 (6), pp. e0216157. Date of Electronic Publication: 2019 Jun 27 (Print Publication: 2019). - Publication Year :
- 2019
-
Abstract
- Introduction: The optimal surgical approach for caesarean section is uncertain in women with very severe obesity (body mass index (BMI) >40kg/m2). We aimed to assess maternal and surgical predictors of surgical site skin infection (SSSI) in very severely obese women and to undertake an exploratory evaluation of clinical outcomes in women with a supra-panniculus transverse compared to an infra-panniculus transverse skin incision.<br />Material and Methods: Using a retrospective cohort design, case-records were reviewed of very severely obese women with a singleton pregnancy delivered by caesarean between August 2011 and December 2015 (n = 453) in two maternity hospitals in Scotland. Logistic regression analysis was used to determine predictors for SSSI. Outcomes were compared between women who had a supra-panniculus transverse compared to infra-panniculus transverse skin incision.<br />Results: Lower maternal age was predictive of SSSI, with current smoking status and longer wound open times being marginally significant. Maternal BMI, suture method and material demonstrated univariate associations with SSSI but were not independent predictors. Women with a supra-panniculus transverse skin incision were older (32.9 (4.4), vs. 30.6 (5.7), p = 0.002), had higher BMI (49.2 (7.1), vs. 43.3 (3.3), p<0.001), shorter gestation at delivery (days) (267.7 (14.9), vs. 274.8 (14.5), p<0.001) and higher prevalence of gestational diabetes mellitus (42.6% vs. 21.9%, p = 0.002). SSSI rates did not differ between supra-panniculus transverse (13/47; 27.7%) and infra-panniculus transverse (90/406; 22.2%; p = 0.395) skin incisions.<br />Conclusion: SSSI rates are high in very severely obese women following caesarean section, regardless of location of skin incision.<br />Competing Interests: The authors have declared that no competing interests exist.
- Subjects :
- Adult
Cesarean Section adverse effects
Female
Gestational Age
Hospitals, Maternity
Humans
Logistic Models
Maternal Age
Pregnancy
Pregnancy Complications
Prevalence
Retrospective Studies
Risk Assessment
Scotland epidemiology
Surgical Wound Infection genetics
Young Adult
Cesarean Section methods
Obesity, Morbid complications
Surgical Wound Infection epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1932-6203
- Volume :
- 14
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- PloS one
- Publication Type :
- Academic Journal
- Accession number :
- 31246973
- Full Text :
- https://doi.org/10.1371/journal.pone.0216157