Can Evidence-Based Interventions Reduce C-section Complications?
BACKGROUND AND PURPOSE:
Temming et. al. (AJOG, 2017) sought to estimate the impact of evidence-based measures to prevent cesarean section wound complications including
Appropriate timing of prophylactic antibiotics within 60 minutes of cesarean delivery and before skin incision
2 g of cefazolin preoperatively for maternal weight <120 kg and 3 g for maternal weight ≥120 kg
Penicillin or cephalosporin allergy: 2 mg/kg gentamicin and 900 mg clindamycin
Chlorhexidine-alcohol for skin antisepsis with 3 minutes of drying time before incision
Closure of subcutaneous layer if ≥ 2 cm of depth
Subcuticular skin closure with suture
Secondary analysis of data from a randomized controlled trial (RCT) of 1082 chlorhexidine-alcohol vs iodine-alcohol for skin antisepsis at cesarean delivery between 2011-2015
Subjects were characterized as one of the following:
Received 4 evidence-based measures (listed above), or
Did not receive the measures
Primary Outcome was a composite of wound complications within 30 days of delivery
Surgical site infection
Individual components of the composite outcome
When comparing patients who received all the evidence-based measures compared with those who did not
The risk of any wound complications was significantly lower (20.3% vs 28.1%; adjusted relative risk 0.75 (95% CI 0.58-0.95)
The impact appeared to be driven by surgical site infection reduction (3.7% vs 9.3%; adjusted relative risk 0.43 (95% CI 0.24-0.76)
Of patients who received evidence-based measures, unscheduled cesarean delivery was the only risk factor for wound complications
Other risk factors, which include obesity, smoking, diabetes mellitus, chorioamnionitis, surgical experience, and skin incision type, were not significantly different between patients who received all measures and those that did not
Implementation of evidence-based measures significantly reduces wound complications
However, the residual risk remains high, suggesting the need for additional interventions, especially to reduce unscheduled cesarean deliveries
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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