SURGICAL SITE INFECTION RISK IN DIABETIC PREGNANT WOMEN UNDERGOING CESAREAN VS. LAPAROTOMY: COMPARATIVE ANALYSIS OF SSI RATES, FACTORING IN GLYCEMIC CONTROL AND PERIOPERATIVE PROTOCOLS.
DOI:
https://doi.org/10.62019/zhp9yd87Keywords:
Diabetes, Pregnancy, Cesarean Section, Laparotomy, Surgical Site Infection, Glycemic Control, Peri-operative BundlesAbstract
Background: Diabetes mellitus is a well-established risk factor for surgical site infections (SSI) due to impaired wound healing, vascular compromise, and perioperative hyperglycemia. In pregnant women, the choice of surgical approach—cesarean delivery versus laparotomy for non-obstetric indications—presents differing SSI risk profiles.
Objective: To compare SSI incidence in diabetic pregnant women undergoing cesarean section versus laparotomy, while factoring in glycemic control and peri-operative preventive protocols.
Methods: A comparative analysis of published cohorts and guideline-based bundles was performed. SSI rates were extracted for cesarean deliveries (clean-contaminated wound class) and open laparotomies (often clean-contaminated/contaminated), with subgroup stratification by glycemic control status (perioperative glucose <180 mg/dL vs. ≥180 mg/dL). Preventive strategies such as antibiotic prophylaxis, skin antisepsis, normothermia, and glucose optimization were evaluated.
Results: Cesarean delivery showed baseline SSI incidence of 2–7%, with risk nearly doubling in poorly controlled diabetics. Open laparotomy carried a higher risk (10–25%), particularly in contaminated cases. Patients with perioperative glucose maintained at 100–180 mg/dL experienced significantly fewer SSIs across both procedures. Preventive bundles—including timely antibiotic prophylaxis (cefazolin ± azithromycin for cesarean, broad spectrum for laparotomy), chlorhexidine-alcohol skin preparation, and strict glucose management—consistently reduced SSI rates.
Conclusion: While cesarean delivery carries a lower baseline SSI risk compared to laparotomy, diabetic status and peri-operative hyperglycemia remain dominant drivers of infection. Rigorous peri-operative glucose control, weight-based antibiotic prophylaxis, and evidence-based bundles can mitigate SSI burden and narrow outcome gaps between the two surgical approaches.
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