Wounds to Wisdom: Exploring Risk Factors and Outcomes for Surgically Managed Postcesarean Wound Infections

Abstract Postcesarean surgical site infections (SSIs) contribute substantially to morbidity and healthcare costs, yet understanding of their management remains limited. Retrospective cohort study of patients delivering via cesarean at a single healthcare system from June 2013 to July 2022 with SSIs within 30 days of delivery. Rates and risk factors for surgical intervention were examined as the primary outcome. Secondary analysis evaluated outcomes in those who required surgical versus conservative management. Of 533 patients, 69 (12.9%) required surgical management; this population was less likely to have private insurance and more likely to have diabetes than patients managed conservatively. Factors independently associated with surgical intervention included body mass index (BMI) 40 to 49.9, BMI ≥ 50, hypertensive disorders of pregnancy, blood transfusion, general anesthesia, and penicillin allergy. Among 297 patients evaluated, patients requiring surgical intervention(n = 69, 23.2%) experienced higher rates of morbidity, including sepsis, acute kidney injury, and fascial dehiscence. Patients requiring surgical intervention had higher rates of inpatient admission, intensive care unit admission, and longer readmissions. Patients with higher BMI, hypertensive disorders of pregnancy, general anesthesia, blood transfusion, and penicillin allergies may warrant closer monitoring for wound infection. Furthermore, patients requiring surgical intervention for postpartum wound infections had higher morbidity and longer, more complex hospitalizations.