Kuan-Sheng Lee1, Yeou-Lih Wang2, Wen-Chu Huang3, Jia-Hwa Yang4, Jian-Pei Huang5. 1. Department of Obstetrics & Gynecology, MacKay Memorial Hospital, Taipei 104, Taiwan. Electronic address: aidsuiop@yahoo.com.tw. 2. Department of Obstetrics & Gynecology, MacKay Memorial Hospital, Taipei 104, Taiwan; MacKay Junior College of Medicine, Nursing and Management, New Taipei City 251, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan. Electronic address: ylw4429@yahoo.com.tw. 3. Department of Obstetrics & Gynecology, MacKay Memorial Hospital, Taipei 104, Taiwan; MacKay Junior College of Medicine, Nursing and Management, New Taipei City 251, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan. Electronic address: wjhuang4438@yahoo.com.tw. 4. Taiwan Public Health Association, Taipei 100, Taiwan. Electronic address: jiahwa3413@gmail.com. 5. Department of Obstetrics & Gynecology, MacKay Memorial Hospital, Taipei 104, Taiwan; MacKay Junior College of Medicine, Nursing and Management, New Taipei City 251, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan. Electronic address: huangjianpei@yahoo.com.tw.
Abstract
BACKGROUND/ PURPOSE: In our experience, adhesion after the primary CS is generally minimal or nonexistent. However, adhesion barriers users have experienced more febrile episodes that may require therapeutic antibiotics during the postcesarean period. We evaluated clinical efficacy of HA-CMC and ORC to prevent adhesion at secondary CS and the post-operative outcome at primary and secondary CS. METHODS: This retrospective study includes 199 Asian women undergoing primary and secondary cesarean section between January1, 2011, and September 31, 2019. We used linear and logistic regression to analyze risk factors of postcesarean fever. An interaction term analysis was performed to examine the effect of surgical site infection risk factors and use of adhesion barrier on postcesarean fever rates. RESULTS: We found that use of adhesion barrier at the primary cesarean section is associated with a significantly higher incidence of postcesarean fever (p = 0.045), which is an independent risk factor of postcesarean fever (adjusted hazard ratio (Adj-HR)= 3.53, 95% CI = 1.03-10.24, p = 0.045). The strongest risk factor for postcesarean fever is the use of anti-adhesion film during emergency cesarean section (p = 0.041). In the subgroup of labor before operation and emergency cesarean section, adhesion barrier user had significant higher risk of postcesarean fever than nonuser (p = 0.018, Adj-HR = 12.12, 95% CI = 1.53-95.78; emergency cesarean section: p = 0.016, Adj-HR = 12.71, 95% CI = 1.62-99.62). CONCLUSION: Use of anti-adhesion films during emergency cases and with a significantly higher risk of postcesarean fever which potentially means increased risk of surgical site infection. Therefore, we do not suggest routine application of anti-adhesion films during cesarean deliveries especially in emergency cesarean section or in a woman having labor before operation.
BACKGROUND/ PURPOSE: In our experience, adhesion after the primary CS is generally minimal or nonexistent. However, adhesion barriers users have experienced more febrile episodes that may require therapeutic antibiotics during the postcesarean period. We evaluated clinical efficacy of HA-CMC and ORC to prevent adhesion at secondary CS and the post-operative outcome at primary and secondary CS. METHODS: This retrospective study includes 199 Asian women undergoing primary and secondary cesarean section between January1, 2011, and September 31, 2019. We used linear and logistic regression to analyze risk factors of postcesarean fever. An interaction term analysis was performed to examine the effect of surgical site infection risk factors and use of adhesion barrier on postcesarean fever rates. RESULTS: We found that use of adhesion barrier at the primary cesarean section is associated with a significantly higher incidence of postcesarean fever (p = 0.045), which is an independent risk factor of postcesarean fever (adjusted hazard ratio (Adj-HR)= 3.53, 95% CI = 1.03-10.24, p = 0.045). The strongest risk factor for postcesarean fever is the use of anti-adhesion film during emergency cesarean section (p = 0.041). In the subgroup of labor before operation and emergency cesarean section, adhesion barrier user had significant higher risk of postcesarean fever than nonuser (p = 0.018, Adj-HR = 12.12, 95% CI = 1.53-95.78; emergency cesarean section: p = 0.016, Adj-HR = 12.71, 95% CI = 1.62-99.62). CONCLUSION: Use of anti-adhesion films during emergency cases and with a significantly higher risk of postcesarean fever which potentially means increased risk of surgical site infection. Therefore, we do not suggest routine application of anti-adhesion films during cesarean deliveries especially in emergency cesarean section or in a woman having labor before operation.