Surgical Bundle to Reduce Infectious Morbidity after Cesarean Delivery in Individuals with Morbid Obesity.

Objective: To evaluate whether the implementation of a surgical bundle reduces surgical site infections (SSI), hospital readmission rates, and emergency department (ED) visits within 6 weeks in individuals with a body mass index (BMI) of 40 kg/m² or greater after cesarean delivery. Methods This was a retrospective study including individuals with morbid obesity undergoing cesarean delivery at 23 weeks of gestation or greater. The pre-intervention period spanned from January 2017 to December 2020. The post-intervention period extended from January 2021 to April 2023. The surgical bundle included standard pre-procedure prophylactic antibiotics and a 48-hour course of oral cephalexin and metronidazole. The primary outcome was SSIs while secondary outcomes included hospital readmission or ED visits within 6 weeks postpartum or wound complications (dehiscence, seroma, or hematoma). Adjusted relative risks (aRR) with 95% Confidence Intervals (95% CI) were calculated using modified Poisson regression, adjusting for potential confounders.

Results: Of 2,105 pregnancies, 1,308 (62.1%) underwent cesarean in the pre-intervention period and 797 (37.9%) in the post-intervention period. Compared to the pre-intervention period, the post-intervention period had increased use of azithromycin (30.6% vs. 35.9%; P =0.012), cephalexin (1.8% vs. 52.8%; P <0.001), and metronidazole (3.1% vs. 60.4%; P <0.001). However, compared to the pre-intervention period, the post-intervention period had a similar risk of SSIs (6.6% vs. 5.9%; aRR 0.92 [95%CI 0.66-1.28]), readmission or ED visits (19.8% vs. 19.8%; aRR 0.94 [95%CI 0.80-1.11]), and wound complications (4.7% vs. 6.4%; aRR 1.37 [95%CI 0.96-1.96]). In individuals with labor or ruptured membranes, the post-intervention period had increased use of azithromycin (74.9% vs. 82.3%; P =0.022), cephalexin (2.5% vs. 56.1%; P <0.001), and metronidazole (4.3% vs. 63.8%; P <0.001). In this subgroup, outcomes remained insignificant.

Conclusions: A morbid obesity surgical bundle increased antibiotic use but did not reduce SSIs, hospital readmission, ED department visits, and wound complications.