Risk Factors for Wound Complications After Obstetric Anal Sphincter Injury

Area of Science:

• Obstetrics
• Gynecology
• Surgical Complications

Background:

• Wound complications following obstetric anal sphincter injury (OASI) can significantly increase patient morbidity and negatively impact quality of life.
• Identifying factors associated with these complications is crucial for improving postpartum care and patient outcomes.

Purpose of the Study:

• To investigate characteristics linked to wound complications after obstetric anal sphincter injury (OASI).
• To determine if operative vaginal delivery is associated with increased complications.
• To assess the protective effect of peripartum antibiotics against OASI wound complications.

Main Methods:

• Retrospective cohort study of patients with OASI treated in a postpartum pelvic floor healing clinic (November 2020 - May 2023).
• Primary outcome: identification of factors associated with wound complications (infection, breakdown, need for antibiotics or surgery).
• Statistical analyses included t-tests, chi-square, Fisher exact test, and multivariable logistic regression.

Main Results:

• 74 out of 332 (22.3%) patients experienced wound complications.
• Older maternal age (P=0.03) and episiotomy (P=0.03) were associated with complications on univariate analysis.
• Multivariable analysis confirmed older maternal age (OR 1.1, P=0.03) and showed peripartum antibiotics were protective (OR 0.57, P=0.04).

Conclusions:

• Older maternal age is a risk factor for OASI wound complications.
• Peripartum antibiotic use demonstrates a protective effect against OASI wound complications.
• Patients with OASI wound complications reported higher rates of pelvic floor disorder symptoms.