Comparing efficacy of preoperative antiseptic agents in preventing SSI after urgent and emergency cesarean section

Authors:
Gabriela Cortese, Robyn Bronshtein, Alex Kaizer, Cameron Maidenberg, Stefka Fabbri, Daniel Yeh

Body of Abstract:
Background: Preoperative skin antisepsis is a well-established method of reducing rates of

postoperative surgical site infection (SSI). The aim of this descriptive study was to assess SSI

rates following emergent cesarean section (e-CS) using different preoperative skin antiseptic

agents.

Methods: This retrospective study included adults undergoing e-CS at our institution between

5/16-12/23. E-CS after trauma and in correctional care patients were excluded. Maternal

demographic information, operative characteristics, and postoperative outcomes were collected.

Two abdominal preparation types were assessed: chlorohexidine gluconate with alcohol (CHG)

for “priority 1” (decision-to-incision < 15 minutes) and povidone-iodine (PVP-I) for “priority 2” (decision-to-incision < 30 minutes). The primary outcome was SSI rate. Additional major co- variates included timeliness of preoperative antibiotics within 60 min before incision (SCIP compliance), appropriateness of antibiotics spectrum (CDC compliance), and postoperative antibiotics treatment and duration. Logistic regression models were used to estimate odds ratios between abdominal preparation types. Results: A total 665 patients were included in the study: CHG=488 (73%) and PVP-I=177 (27%) (Table). Significant differences were seen between groups regarding indication for e-CS, preoperative antibiotics administration, timeliness of preoperative antibiotics, post-operative antibiotics prescription, and duration of postoperative antibiotics. However, the overall SSI rate was 4.2% and SSI rates were not significantly different between groups (3.9% vs. 5.1%, p=.164). Adjusted logistic regression demonstrated that PVP-I vs. CHG was not associated with increased risk of SSI (OR 1.18, 95% CI 0.48-2.88, p=.712). Conclusion: The choice of preoperative skin antisepsis agent at our institution is variable and may depend upon factors such as indication for e-CS. We did not detect a meaningful difference in SSI rates between different antiseptic agents. These findings indicate that SSI rates may not be impacted by type of preoperative skin antiseptic agent.