Surgical Bundle to Reduce Infectious Morbidity after Cesarean Delivery in Individuals with Morbid Obesity

Abstract

Objective

This study aimed to evaluate whether the implementation of a surgical bundle reduces surgical site infections (SSI), hospital readmission rates, and emergency department (ED) visits within 6 weeks in individuals with a body mass index (BMI) of 40 kg/m² or greater after cesarean delivery.

Study Design

This was a retrospective study including individuals with morbid obesity undergoing cesarean delivery at 23 weeks of gestation or greater. The preintervention period spanned from January 2017 to December 2020. The postintervention period extended from January 2021 to April 2023. The surgical bundle included standard preprocedure prophylactic antibiotics and a 48-hour course of oral cephalexin and metronidazole. The primary outcome was SSIs while secondary outcomes included hospital readmission or ED visits within 6 weeks postpartum or wound complications (dehiscence, seroma, or hematoma). Adjusted relative risks (aRR) with 95% confidence intervals (95% CI) were calculated using modified Poisson regression, adjusting for potential confounders.

Results

Of 2,105 pregnancies, 1,308 (62.1%) underwent cesarean in the preintervention period and 797 (37.9%) in the postintervention period. Compared to the preintervention period, the postintervention period had increased use of azithromycin (30.6 vs. 35.9%; p = 0.012), cephalexin (1.8 vs. 52.8%; p < 0.001), and metronidazole (3.1 vs. 60.4%; p < 0.001). However, compared to the preintervention period, the postintervention period had a similar risk of SSIs (6.6 vs. 5.9%; aRR: 0.92; 95% CI: 0.66–1.28), readmission or ED visits (19.8 vs. 19.8%; aRR: 0.94; 95% CI: 0.80–1.11), and wound complications (4.7 vs. 6.4%; aRR: 1.37; 95% CI: 0.96–1.96). In individuals with labor or ruptured membranes, the postintervention period had increased use of azithromycin (74.9 vs. 82.3%; p = 0.022), cephalexin (2.5 vs. 56.1%; p < 0.001), and metronidazole (4.3 vs. 63.8%; p < 0.001). In this subgroup, outcomes remained insignificant.

Conclusion

A morbid obesity surgical bundle increased antibiotic use but did not reduce SSIs, hospital readmission, ED department visits, and wound complications.

Key Points

• A surgical bundle for individuals with morbid obesity increased the use of postoperative antibiotics.

• The surgical bundle did not significantly reduce SSIs.

• The surgical bundle did not significantly reduce hospital readmissions and ED visits.

Keywords

surgical bundle - morbid obesity - infection - readmission - emergency department

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