Wound infection after cesarean: effect of subcutaneous tissue thickness

Objective: To estimate the effect of the thickness of subcutaneous tissue at the surgery site on abdominal wound infection after cesarean delivery. Methods: We measured the maximum vertical depths of subcutaneous incisions of women who had cesarean deliveries. The surgical technique for closure was standardized and drains were not used. Abdominal wound infection was defined by standard criteria and limited to the first 6 postoperative weeks. Additional demographic, intrapartum, and perioperative data previously associated with wound infection also were collected. Data were analyzed by Student t test, χ 2 test, and multiple logistic regression. Results: Wound infection occurred in 11 of 140 women (7.8%) who delivered by cesarean. Risk factors identified as significantly associated with wound infection by univariate analysis were thickness of subcutaneous tissue, maternal weight, and body mass index. Multiple logistic regression analysis confirmed subcutaneous tissue thickness as the only significant risk factor for wound infection, with a relative risk of 2.8 (95% confidence interval 1.3, 5.9). There were no significant differences between women who developed wound infections and those without infections in terms of selected demographics, duration of ruptured membranes, number of vaginal examinations, chorioamnionitis, type of skin incision, or duration of surgery. Conclusion: Thickness of subcutaneous tissue appears to be the only significant risk factor associated with abdominal wound infection after cesarean delivery.