Risk Factors for Surgical Site Infection following Cesarean Delivery
Location
Center for Advanced Learning & Simulation (CALS)
Publication Date
May 2026
Start Date
8-5-2026 9:00 AM
End Date
8-5-2026 9:15 AM
Description
Background: Surgical site infections (SSIs) following Cesarean delivery (CD) are a significant cause of maternal morbidity, with global incidence estimates of 2–8%. Understanding modifiable and non-modifiable risk factors is essential for developing prevention strategies, particularly in high-risk populations in the southern United States. This study aims to identify predictors of SSI after CD at a high-volume obstetric center in South Louisiana with the overall goal of building upon existing evidence-based recommendations to remain proactive against a known cause of maternal morbidity.
Methods: We conducted a retrospective cohort study of 4,949 women who delivered via CD at Woman's Hospital from March 2024 to December 2025. Data were extracted from the Women and Infants Clinical (WINC) database. SSI was defined as infection at the surgical site within 30 postoperative days. Candidate predictors were assessed via univariable logistic regression, followed by multivariable logistic regression adjusted for relevant maternal demographic and clinical covariates.
Results: SSI occurred in 119 of 4,949 patients (2.4%). Univariable analysis identified BMI, gestational age, race, ASA classification, surgery duration, and hours of labor as significant candidates. Each 1-unit BMI increase was associated with a 6% increase in SSI odds (OR 1.06, 95% CI 1.04–1.08). Each additional operative minute increased SSI odds by 1% (OR 1.01, 95% CI 1.01–1.02), and each additional hour of labor increased odds by 2% (OR 1.02, 95% CI 1.00– 1.03). On multivariable analysis, surgery duration (aOR 1.01, 95% CI 1.00–1.02), and hours of labor (aOR 1.02, 95% CI 1.00–1.03) were independent predictors of SSI. Remaining maternal, obstetric, and perioperative factors did not significantly contribute to SSI risk.
Conclusions: On multivariable analysis, operative duration, and hours of labor were independent predictors of SSI, with surgery duration standing out as a clinically modifiable target that underscores the importance of efficiency in the operating room. Laboring status did not significantly increase risk, which is a notable finding given common assumptions about this exposure. The null findings for diabetes and hypertension likely reflect the low prevalence of SSI in this cohort rather than a true absence of effect. Future directions include expanding the dataset and comparing risk factor profiles across regions to better characterize SSI risk in diverse obstetric populations. These findings provide a foundation for targeted prevention efforts aimed at reducing a known source of maternal morbidity.
Recommended Citation
Schwartzenburg, Kayla MD; Buzhardt, Sarah MD; Dinh, Dina MS; Collins, J. Hunter; and Sutton, Elizabeth F. PhD, "Risk Factors for Surgical Site Infection following Cesarean Delivery" (2026). Dept. of Obstetrics & Gynecology Resident Research Day. 2.
https://digitalscholar.lsuhsc.edu/obgyn_rd/2026/presentations/2
Risk Factors for Surgical Site Infection following Cesarean Delivery
Center for Advanced Learning & Simulation (CALS)
Background: Surgical site infections (SSIs) following Cesarean delivery (CD) are a significant cause of maternal morbidity, with global incidence estimates of 2–8%. Understanding modifiable and non-modifiable risk factors is essential for developing prevention strategies, particularly in high-risk populations in the southern United States. This study aims to identify predictors of SSI after CD at a high-volume obstetric center in South Louisiana with the overall goal of building upon existing evidence-based recommendations to remain proactive against a known cause of maternal morbidity.
Methods: We conducted a retrospective cohort study of 4,949 women who delivered via CD at Woman's Hospital from March 2024 to December 2025. Data were extracted from the Women and Infants Clinical (WINC) database. SSI was defined as infection at the surgical site within 30 postoperative days. Candidate predictors were assessed via univariable logistic regression, followed by multivariable logistic regression adjusted for relevant maternal demographic and clinical covariates.
Results: SSI occurred in 119 of 4,949 patients (2.4%). Univariable analysis identified BMI, gestational age, race, ASA classification, surgery duration, and hours of labor as significant candidates. Each 1-unit BMI increase was associated with a 6% increase in SSI odds (OR 1.06, 95% CI 1.04–1.08). Each additional operative minute increased SSI odds by 1% (OR 1.01, 95% CI 1.01–1.02), and each additional hour of labor increased odds by 2% (OR 1.02, 95% CI 1.00– 1.03). On multivariable analysis, surgery duration (aOR 1.01, 95% CI 1.00–1.02), and hours of labor (aOR 1.02, 95% CI 1.00–1.03) were independent predictors of SSI. Remaining maternal, obstetric, and perioperative factors did not significantly contribute to SSI risk.
Conclusions: On multivariable analysis, operative duration, and hours of labor were independent predictors of SSI, with surgery duration standing out as a clinically modifiable target that underscores the importance of efficiency in the operating room. Laboring status did not significantly increase risk, which is a notable finding given common assumptions about this exposure. The null findings for diabetes and hypertension likely reflect the low prevalence of SSI in this cohort rather than a true absence of effect. Future directions include expanding the dataset and comparing risk factor profiles across regions to better characterize SSI risk in diverse obstetric populations. These findings provide a foundation for targeted prevention efforts aimed at reducing a known source of maternal morbidity.
Comments
Advisor: Sarah Buzhardt MD