Grand Rounds

Can Evidence Based Interventions Reduce C-section Complications?

BACKGROUND AND PURPOSE:

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:
- Received 4 evidence-based measures (listed above)
- Did not receive the measures
Primary Outcome was a composite of wound complications within 30 days of delivery
- surgical site infection
- cellulitis
- seroma
- hematoma
- wound separation
Secondary outcomes
- Individual components of the composite outcome

When comparing 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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