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

METHODS:

• 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
  • Cellulitis
  • Seroma
  • Hematoma
  • Wound separation
• Secondary outcomes
  • Individual components of the composite outcome

RESULTS:

• 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

CONCLUSION:

• 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

Learn More – Primary Sources:

Impact of evidence-based interventions on wound complications after cesarean delivery