# Predictors of surgical site infections following cesarean delivery in public hospitals of West Ethiopia: A cohort study

## TL;DR

This study identifies risk factors for surgical site infections after cesarean deliveries in Ethiopia, emphasizing the need for targeted interventions to reduce infection rates.

## Contribution

The study expands on previous Ethiopian research by including new risk factors and using a multi-hospital cohort design.

## Key findings

- The incidence rate of surgical site infection was 9.4 per 1000 person-days.
- Emergency Cesarean delivery and presence of meconium were significant predictors of surgical site infection.
- Consistent antibiotic prophylaxis is recommended to reduce infection risk.

## Abstract

Surgical site infection rates after cesarean delivery among women who delivered are increasing at an alarming rate. This results in maternal mortality, disability, prolonged hospital stay, significant financial expense, psycho-social disturbance, antibiotic resistance, and a window period opportunity missed for the baby. Despite previous Ethiopian studies on surgical site infection after cesarean delivery with a cohort design being conducted in a single center and did not consider certain risk factors, which limited their findings. This study accounts for factors such as the American Society of Anesthesiologists (ASA) class, postoperative hemoglobin levels, presence of meconium, postpartum hemorrhage, and antibiotic prophylaxis. This study aimed to determine the incidence and predictors of surgical site infection post- cesarean delivery among women who gave birth in public hospitals in the East Wollega Zone, West Ethiopia.

A hospital-based prospective cohort study was conducted in East Wollega public hospitals from 15th January to 14th April, 2024, involving 408 participants selected consecutively. We entered data using Epi-Data version 4.6 and exported to STATA version 14 for analysis. The Kaplan-Meier method was used to estimate surgical site infection. The Cox proportional hazard assumptions were checked using Schoenfeld residual statistics, while the Cox-Snell residual test was used to check the final model’s adequacy. Then, in a multi-variable analysis, variables with a p-value < 0.05 were declared as predictors of surgical site infection.

The incidence rate of SSI is 9.4/1000 person/day (95% CI: 7.5, 11.6). Presence of meconium (AHR = 2.37, 95% CI: 1.3, 4.12), emergency Cesarean delivery (AHR = 2.5, 95% CI: 1.16, 5.41), American Society of Anesthesiologists class ≥ III (AHR = 5.3, 95% CI: 2.8, 9.78), postoperative hemoglobin <11 g/dl (AHR = 1.78, 95% CI: 1.04, 3.06), and absence of antibiotic prophylaxis (AHR = 2.46, 95% CI: 1.4, 4.21) were identified as statistically significant predictors of surgical site infection among post cesarean delivery mothers.

This study demonstrated a significant incidence density of surgical site infection within the study area. For the identified predictors, the authors recommend the need for target interventions particularly, the consistent administration of antibiotic prophylaxis and vigilant monitoring of patients with existing health complications or those undergoing emergency procedures to reduce the burden of surgical site infection in this area.