(399) Predictors of Postpartum Infection Morbidity Following Cesarean Delivery

This is a secondary analysis of a multicenter randomized trial of tranexamic acid (TXA) versus placebo at the time of cesarean section to reduce blood transfusion, which was not affected by the intervention. For this analysis, the primary outcome was a composite infection complication, including surgical site infection (SSI; CDC definition), pelvic abscess, or endometritis. Trained research personnel ascertained outcomes through medical record abstraction. Univariable analysis and multivariable model with logistic regression with stepwise selection were used to identify predictors. Receiver operator curve (ROC) analysis was performed using the variables that remained in the model.


Results: Overall, 10995 participants were enrolled, and 287 (3%) had the composite infection complication (SSI 185 [64%], endometritis: 96 [34%], and pelvic abscess 10 [4%]).  Results of the univariable analysis are summarized in Table 1. The variables that remained in the model after adjustment were tobacco use, BMI at delivery, preterm delivery, labored before CD, length of surgery, uterine incision extension, and use of uterotonics other than oxytocin (Table 2). The final ROC for the predictive model had an AUC of 0.6 (95% CI 0.6-0.7).

Conclusion:

Although several pre and perioperative characteristics were associated with post-cesarean infection morbidity taken together, they provided modest predictive ability. This model may help risk-stratify for post-operative surveillance or quality improvement programs.