Time to Development Of Surgical Site Infection And Its Predictors Among Women Who Underwent Cesarean Delivery In Southwest Shewa Zone Hospitals, Ethiopia

Abstract

Background: Surgical site infection is the most frequent healthcare-associated infection following cesarean delivery and is linked to higher maternal morbidity and mortality rates. Estimated incidence rates of post-cesarean surgical site infection in different world regions range from 1% to 20%. These estimates of the rate of surgical site infection often fail to take account of infection that occur after hospital discharge and the time required to develop surgical site infection following cesarean delivery wasn’t properly addressed in our country. Objective: To assess time to development of surgical site infection and its predictors among women who underwent cesarean delivery in southwest Shewa Zone Hospitals, Ethiopia,2023. Methods: A prospective cohort study design was employed among 264 participants from April 12th to July 22, 2023. Study participants from each hospital were serially enrolled. Data were collected by interviewer-administered questionnaires, telephone interviews, and reviewing mothers’ hospital records/charts. The data were cleaned, coded, and entered into EpiData version 4.6 and then exported to SPSS version 26 for analysis. The development of SSI was estimated using the Kaplan-Meier method. The log-rank test was performed to compare the estimated survival curves of participants based on categorical variables. An adjusted hazard ratio (AHR) with a 95% confidence interval was used to report the strength of the association between the outcome variable and risk factors. Result: Among 264 participants, 251 (95.1%) of them completed the 30-day follow up period, while 13(4.9%, CI: 2.80-8) were lost before completing the follow-up. The overall incidence rate of surgical site infection was 50.4 per 10,000 people/day. Pregnancy induced hypertension(AHR=2.76, 95%CI: 1.002, 7.585), anemia before cesarean delivery (AHR=2.69, 95%CI: 1.298, 5.553), previous history of CS (AHR=, 95%CI: 1.276, 7.227), vertical type of incision (AHR=3.5, 95%CI:1.292, 9.427), spinal anesthesia (AHR=0.339, 95%CI: 0.133, 0.864), prolonged rupture of membrane (AHR=3, 95%CI: 1.320, 6.839) were predictors for development of surgical site infection at a p-value of 0.05. Conclusion: All surgical site infection following cesarean delivery occurred between the 3rd and 14th days with median time of occurrence 6 days and interquartile range of 4-7 days. The main predictors of the development of surgical site infection following cesarean delivery were anemia before cesarean delivery, pregnancy induced hypertension, prolonged rupture of membrane, type of skin incision, previous history of cesarean section and anesthetic technique.