The relationship between obesity and surgical site infections in women undergoing caesarean sections: an integrative review

Objective: to provide a critical evaluation of published research on the relationship between obesity and surgical site infection (SSI) in obese women undergoing caesarean section.

Method: an integrative literature review was conducted using five databases (CINAHL, PUBMED, Cochrane, and EBSCO host) for 2002-2012. Inclusion criteria were: (1) wound infection as an outcome measure for obstetric/maternal complications; (2) obesity assessed as an independent risk factor for wound infection in women undergoing caesarean section; (3) research undertaken in the past 10 years; and (4) full text articles available in English with abstract. A two point assessment score was used to evaluate the included studies in relation to representativeness of sample; accuracy of measures in data collection; and appropriateness of analytic techniques; (5) Databases where accessed including PubMed and MedLine. an intergrative literature review was conducted using four databases.

Findings: thirteen research-based papers met the inclusion criteria, and the selected papers used various designs and methods. Five out of 13 studies scored highly in all three quality domains. All 13 studies supported a relationship between obesity and SSI and caesarean section was more common in obese women.

Conclusion: obesity is a global priority health concern affecting all ages and as demonstrated in this review, can result in serious postoperative complications for child bearing women undergoing caesarean section such as SSI. Further research is required into wound management practices of the obese women following caesarean section as this is an area currently lacking high quality research.

Implications for practice: community midwives are well positioned to implement wound assessments in this cohort of women post-discharge, when SSI is often detected.