Incision length: an emerging risk factors for surgical‐site infection following cesarean section

Tripti Nagaria, Avinashi Kujur, Neha Thakur


Background: Since late nineteenth century, the caesarean section first done there is a tremendous improvement in the surgical and anaesthetic skills. It has emerged as a safe mode of delivery but now, in the present era there is a continuous rising trend of caserean section. Objective of present study is to evaluate the effect of some specific gestational factors and other known variables associated with poor wound healing in women who delivered by cesarean section.

Methods: A total of 1215 women delivered by cesarean section at Pt. JNM Medical college, Raipur, Chhattisgarh, India from May 2014 to April 2015 were included in this study. The BMI was measured at gestational age when she got operated, grade of surgeons was noted. Subcutaneous tissue depth was intra-operatively measured from the fascia to the skin surface, while the incision length was measured after skin closure.

Results: Out of 1215 women operated 251 cases developed SSI with incidence of 20.5%. Incision length (OR 2.40, 95% CI 2.11-2.73; p<0.0001), Body mass index (BMI) at term (OR 2.9, 95% CI 1.82-4.44; <0.0001), previous caesarean section scar (OR 0.72, 95% CI 0.54-0.96; p=0.02), Grade of surgeon (OR 5.5, 95% CI 3.3-9.3; p<0.0001), subcutaneous tissue thickness (OR 1.88, 95% CI 1.60-2.23, p<0.0001) were found to be correlated with wound complications. The receiver operating characteristics curve analysis suggested a cut-off of 28.7 for the BMI at term with AUC 0.8 (0.79-0.84, p<0.0001) and 147 mm for the wound length with an AUC 0.8 (95% CI 0.78-0.82; p <0.0001). The multivariate logistic regression model, applied to these variables showed an independent correlation of incision length with SSI   incision length >14.7; OR 2.40, 95% CI 2.11-2.73, p<0.0001.

Conclusions: Incision length by itself was found to be an independent risk factor for development of surgical site infection.


BMI, Incision length, Surgeon skill, Surgical site infection

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