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

Area of Science:

• Obstetrics and Gynecology
• Surgical Quality Improvement
• Infectious Disease Prevention

Background:

• The Surgical Care Improvement Project (SCIP) mandates prophylactic antibiotic administration within 60 minutes before incision for surgical procedures.
• Emergent cesarean sections (CSs) present unique challenges to adhering to prophylactic antibiotic timing guidelines.
• Assessing SCIP compliance in emergent CSs is crucial for identifying and addressing potential gaps in care.

Purpose of the Study:

• To evaluate the adherence to SCIP guidelines for prophylactic antibiotic administration in emergent cesarean sections (CSs).
• To identify factors associated with non-compliance with SCIP recommendations in this patient population.
• To pinpoint areas for quality improvement in the perioperative care of patients undergoing emergent CSs.

Main Methods:

• A retrospective study was conducted on 876 patients undergoing emergent CSs between May 2016 and December 2023.
• Data abstracted included maternal demographics, obstetric and medical factors, and labor outcomes.
• Logistic regression analysis was used to determine predictors of SCIP compliance, with primary outcome being timely antibiotic administration.

Main Results:

• Antibiotics were administered in 98% of cases, but only 73% met SCIP compliance criteria (within 60 minutes of incision).
• Predictors of SCIP non-compliance included higher American Society of Anesthesiologists (ASA) class (Class 3, 4/5) and prolapsed cord as the indication for CS.
• Maternal morbidity was low, with a 4% surgical site infection (SSI) rate, though a 5% loss to follow-up rate may introduce bias.

Conclusions:

• Timeliness of pre-operative antibiotic administration, abdominal skin preparation, and post-discharge follow-up represent key areas for quality improvement in emergent CSs.
• SCIP non-compliance is significantly associated with the emergent nature of the cesarean delivery and higher patient ASA class.
• While post-operative SSI rates were low, the study acknowledges potential bias due to loss to follow-up, highlighting the need for improved follow-up protocols.