Emergency Cesarean Section Pre-operative Antibiotic Agent Prophylaxis—Opportunities for Improvement

Abstract

Background:

Surgical Care Improvement Project (SCIP) recommends prophylactic antibiotic agents (abx) within 60 min before incision. This quality improvement study assessed SCIP compliance in emergent cesarean sections (CSs) to identify opportunities for improvement.

Methods:

This retrospective study included patients undergoing emergent CSs at our institution between May 2016 and December 2023. Maternal demographic, obstetric, medical, and labor outcomes were abstracted. The primary outcome was the incidence of timely (within 60 min of incision) administration of abx. Secondary outcomes included maternal intensive care unit (ICU) admission, hospital length of stay (LOS), loss to follow-up, surgical site infection (SSI), and 30-day outcomes. Logistic regression analyses were performed to identify predictors of SCIP compliance.

Results:

A total of 876 patients were included in the study. The most common indication for CSs was non-reassuring fetal status, and the most common form of anesthesia was epidural. Abx were administered in 98% of cases, but only 73% were SCIP compliant. Chlorhexidine-alcohol was most commonly used for abdominal skin preparation. There were significant differences between the SCIP Not Compliant versus Compliant group, but multiple logistic regression identified only American Society of Anesthesiologists (ASA) Class 3 (OR: 0.69 95% CI: 0.49–0.97, p = 0.034), ASA Classes 4/5 (OR: 0.22 95% CI: 0.04–0.96, p = 0.047), and prolapsed cord as indication for CSs (OR: 0.22 95% CI: 0.10–0.49, p < 0.001) as predictors of SCIP Not Compliant. Maternal morbidity was low, with only 2% ICU admission and median hospital LOS 4 days. Only (5%) were lost to follow-up. SSI rate was low (4%).

Conclusion:

We identified timeliness of pre-operative abx administration, abdominal skin preparation agent, and post-discharge follow-up as opportunities for improvement. SCIP non-compliance was significantly associated with emergent cesarean indication and higher ASA class. Post-operative SSI rates were low, though bias may be present because of the high loss-to-follow-up.