The relationship between surgeon experience and endometritis after cesarean section.

We studied 294 primary cesarean section and repeat cesarean section deliveries with premature rupture of membranes which occurred over a two year period to determine if an association existed between postoperative endometritis and the level of physician training. The results of preliminary analysis revealed that a relationship existed between the level of physician training and the presence of endometritis (p less than 0.01). Endometritis rates for patients under the care of attending physicians, chief residents and residents serving as the primary surgeon were six, 13 and 24 per cent, respectively. Stepwise discriminant function analysis allowed us to account for the contribution of independent risk factors for endometritis. When surgeon experience was evaluated with other risk factors, the presence of a resident serving as the lead surgeon and the age of the patient were the only significant predictors of endometritis (p = 0.046 and 0.007, respectively). The clinical and biologic relevance of the actual age difference between infected and noninfected patients (22 years for infected patients versus 25 years for noninfected patients) is not readily apparent. However, in this study, the identification of a resident acting as a lead surgeon has been shown to be a new independent risk factor for predicting endometritis. This study demonstrates the need for the evaluation of training programs for residents who serve as the principal surgeon for patients who underwent cesarean section.