Barriers to Effective Wound Healing in Surgical Site Infection Following Cesarean Section.

Background: Cesarean section (CS) is the most common surgical procedure worldwide and although usually safe is sometimes associated with morbidity and mortality. Surgical site infection (SSI) post-CS is a frequently encountered cause of prolonged hospitalization and financial burden on the healthcare system. The reported incidence is 9%-17%. Risk factors are poor antenatal care, comorbidities, chorioamnionitis, prolonged labor, improper use of antibiotics, and emergency delivery. Although enormous data are available regarding the risk factors for SSI, not much information exists about factors affecting wound healing.

Aim: The aim is to evaluate the barriers to effective wound healing and response after primary management in SSI among women undergoing CS.

Methods: A prospective study was done enrolling 100 women with SSI post-CS. Swabs were taken from those with SSI and cultures were done. Wound characteristics and healing were followed. Data were collected and analyzed.

Results: Most were primiparous (44%) and 66% of CS were emergency during labor. Factors which significantly affected healing were socio-economic status, emergency/elective delivery, surgery in labor or prelabor, personal hygiene, history of previous CS, anemia, Southampton wound grade, duration since membrane rupture >18 h, and day of primary wound repair since presentation (P < 0.05). Longer mean duration of day since surgery and delayed primary repair also significantly affected wound healing.

Conclusion: SSI may not always be avoidable. Predicting the risk with associated factors and judicious use of antibiotics may help reduce the incidence.