Wound Disruption Following Cesarean Delivery in Women With Class III Obesity, a Retrospective Observational Study [36J]

INTRODUCTION: Class III obese women are at increased risk for wound complications following cesarean delivery (CD). We evaluated the CD wound disruption rate in women with class III obesity, and identify underlying risk factors. METHODS: Class III obese women who underwent CD >24 weeks of gestation at our hospital, between 2011 and 2015 were included. Data on demographics, clinical history were collected. Information regarding the CD included and also Information regarding the perioperative period. Multivariable logistic regression analysis was performed to identify risk factors likely to contribute to higher wound disruption rates. RESULTS: Three hundred thirty-four cases of class III obese women, with mean age 32.96+5.19 and mean BMI of 48.20+7.52. The most frequently used skin incision was Pfannenstiel (75.6%). The subcutaneous tissue was most likely to be closed (65.4%). The skin was most likely to be closed with staples (66%) with the use of a pressure dressing (65%). DVT prophylaxis was administered in 71.7% of cases. We had 18% wound disruption rates. Wound disruption rates were higher if surgical time was >1 hour (odds ratio [OR]=2.03, 95% confidence interval [CI] 1.13–3.65, P =.017) and if DVT prophylaxis was used (OR=2.22, 95% CI 1.08–4.59, P =.031). On multivariable logistic regression, surgical time >1 hour (OR=1.88, P =.050), but not DVT prophylaxis (OR=1.64, P =.22) remained statistically significant. CONCLUSION: We found that surgical time >1 hour was the only statistically significant risk factor for wound disruption. We had 18% wound disruption rates. The role of other risk factors, in particular the use of DVT prophylaxis warrants further investigation.