Incidence and risk factors of surgical site infection following cesarean section: a retrospective cohort study

Abstract

Background: Surgical site infections (SSIs) are a significant concern in developing countries, with prevalence rates affecting a substantial portion of patients undergoing surgical procedures. In urban, the rate of Cesarean Sections (CSs) remains high. Objective: To assess the cumulative incidence and risk factors for SSIs following CS at an urban district hospital in Kigali, Rwanda. Methods: We conducted a retrospective cohort study at Muhima, a specialized maternal and pediatric referral district hospital in Kigali, Rwanda. The study included 373 women who underwent CS between August 2019 and August 2022, systematically selected from operating theatre and medical records. Data were analyzed using SPSS version 27. Descriptive statistics determined the SSIs proportion. Bivariate chi-square tests and binary logistic regression identified independent risk factors. Results: The mean participant age was 30.36 years (SD 6.06). The SSIs incidence post-CS was 11.3% (95% CI 7.80–14.18). Maternal age ≥ 35 years was the predictor (AOR = 5.12, 95% CI 1.10–23.95, p = 0.038). Protective factors included urban residence (AOR = 0.01, 95% CI 0.003–0.08, p < 0.001), Ubudehe (income) category 2 (AOR = 0.06, 95% CI 0.01–0.33, p = 0.001), procedure duration < 45 min (AOR = 0.05, 95% CI 0.008–0.34, p = 0.002), pre-operative glycaemia ≥ 70 mg/dL (AOR = 0.08, 95% CI 0.01–0.69, p = 0.020), and pre-operative hematocrit ≥ 33% (AOR = 0.09, 95% CI 0.01–0.59, p = 0.013). Conclusions: SSIs post-CS remain a significant concern, with an 11.3% incidence rate. Older maternal age was a significant predictor of infection, while several clinical and socioeconomic factors appeared protective. Targeted preventive measures can reduce the burden of SSIs post CS.