Implementation of an Abdominal Closure Bundle in Patients Undergoing Cesarean Section—A Randomized Control Trial [15P]. (May 2020)

• Record Type: Journal Article
• Authors: Bruce, Shaina; Rajendran, Preethi; Mumford, Brigid; Heidorn, Elise; Smith, Stephen
• Is Part Of: Obstetrics and gynecology. Volume 135(2020)Supplement 1
• Publication Date: 2020-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000663916.73299.9c
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: Surgical site infections (SSI) are associated with increased morbidity, mortality, and healthcare costs. Literature in Colorectal Surgery and Gynecologic Oncology have suggested lower SSI rates among patients who receive closure bundles. This study investigated whether implementation of an abdominal closure bundle reduces SSI rates in patients undergoing cesarean section. METHODS: We conducted a prospective randomized controlled trial of patients who underwent a scheduled cesarean section. Enrolled patients were randomized to either standard operative procedure or the abdominal closure bundle. The bundle included changing of the surgical gown and gloves, repeat scrub, and usage of new instruments for closure of fascia, subcutaneous tissue, and skin. SSI rates were assessed and predictors of SSI were determined. RESULTS: 241 patients were included in this interim analysis. No difference in SSI was found between the control (3/130, 2.3%) and closure bundle (2/111, 1.8%) groups (P=1.00). Logistic regression indicated that smoking status and number of prior cesarean sections were statistically reliable predictors of SSI (P=.009). Former or active smokers were 8.3 times more likely to have an infection (CI 1.61 – 43.3, P=.012). Those with prior cesarean sections were 2.5 times more likely to have an infection (CI 1.0 – 6.1, P=.045). CONCLUSION: Implementation of an abdominal closure bundle for patients undergoing scheduled cesarean sections did not significantly reduce SSI rate. We plan to investigate the impact of the abdominal closure bundle in a higher risk population as completion of this study as designed is unlikely to reach statistical significance.