Cesarean Section Incision Complications and Associated Risk Factors: A Quality Assurance Project


Background: Today in the United States, approximately 30% of deliveries are performed by cesarean section. Wound infections and other post-operative complications represent a frequent morbidity which may be improved with an understanding of local risk factors. Objective: This project used a retrospective analysis of cesarean section incision complications and infection events along with patient chart information to identify potential risk factors associated with incisional wound complications at our institution. Methods: ICD9 codes identified 618 cesarean sections from July 2012 through June 2013. Of these, 59 were excluded. Twelve different data elements were examined and complications were divided into two categories: presence of infection and presence of seroma/hematoma. Statistics included univariate analysis and multiple logistic regressions to identify an odds ratio for associations using P < 0.05 as significant. Results: 73 (13.1%) of 559 patients developed a post-partum incision complication. Five logistic variables were included in amultiple logistic regression model for all incision complications. Three of the five variables had a significant odds ratio: emergent cesarean section, stapled skin closure, and preeclampsia. Five logistic variables were included in another multiple logistic regression model for all wound infections. Two of the five variables had a significant odds ratio: BMI > 33.4 and preeclampsia. Conclusions: Cesarean section rates account for approximately 30% of deliveries, with significant maternal morbidity associated with incisional wound complications. This study found multiple significant risk factors for both wound complications and infections. Preeclampsia was an independent risk factor for both wound complications and infections.

Share and Cite:

Newlin, C. , Kuehl, T. , Pickrel, A. , Cawyer, C. and Jones, R. (2015) Cesarean Section Incision Complications and Associated Risk Factors: A Quality Assurance Project. Open Journal of Obstetrics and Gynecology, 5, 789-794. doi: 10.4236/ojog.2015.514111.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine (2014) Obstetric Care Consensus No. 1: Safe Prevention of the Primary Cesarean Delivery. Obstetrics & Gynecology, 123, 693-711.
[2] Tran, T.S., Jamulitrat, S., Chongsuvuvatwongm, V. and Geater, A. (2000) Risk Factors for Postcesarean Surgical Site Infections. Obstetrics & Gynecology, 95, 367-371.
[3] Basha, S.L., Rochon, M.L., Quinones, J.N., Coassolo, K.M., Rust, O.A. and Smulian, J.C. (2010) Randomized Controlled Trial of Wound Complication Rates of Subcuticular Suture vs Staples for Skin Closure at Cesarean Delivery. American Journal of Obstetrics & Gynecology, 203, 285.e1-285.e8.
[4] Figueroa, D., Jauk, V.., Szychowski, J.M., Garner, R., Biggio, J.R., Andrews, W.W., Hauth, J. and Tita, A.T.N. (2013) Surgical Staples Compared with Subcuticular Suture for Skin Closure after Cesarean Delivery: A Randomized Controlled Trial. Obstetrics & Gynecology, 121, 33-38.
[5] Myles, T.D., Gooch, J. and Santolaya-Forgas, J. (2002) Obesity as an Independent Risk Factor for Infectious Morbidity in Patients Undergoing Cesarean Delivery. Obstetrics & Gynecology, 100, 959-964.
[6] Pevzner, L., Swank, M., Krepel, C., Wing, D.A., Chan, K. and Edmiston Jr., C.E. (2011) Effects of Maternal Obesity on Tissue Concentrations of Prophylactic Cefazolin during Cesarean Delivery. Obstetrics & Gynecology, 117, 877-882.
[7] Vermillion, S.T., Lamoutte, C., Soper, D.E. and Verdeja, A. (2000) Wound Infection after Cesarean: Effect of Subcutaneous Tissue Thickness. Obstetrics & Gynecology, 95, 923-926.
[8] Chelmow, D., Rodriguez, E.J. and Sabatini, M.M. (2004) Suture Closure of Subcutaneous Fat and Wound Disruption after Cesarean Delivery: A Meta-Analysis. Obstetrics & Gynecology, 103, 974-980.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.