341: Negative pressure wound therapy reduces cesarean delivery surgical site infections in morbidly obese women

Morbidly obese women have the highest rate of cesarean delivery surgical site infections (SSI). Complications associated with infections in these women lead to readmissions and significant medical costs. We evaluated the use of negative pressure wound therapy (NPWT) to decrease cesarean delivery SSIs in morbidly obese women. Retrospective cohort study of morbidly obese pregnant women (BMI ≥ 40) undergoing cesarean delivery from January 2014 to June 2016. Beginning in January 2015, the institution began using prophylactic NPWT on all women with a BMI ≥ 40. Prior to January 2015, women received a standard of care dressing (SoC). The main outcome was the diagnosis of a SSI using CDC criteria. A secondary outcome was all wound complications including infection, seroma, or hematoma. The cohort included 317 women with 210 (66%) women utilizing NPWT. The NPWT group had a higher median BMI (48.2 vs. 44.6, p <0.001), more vertical skin incisions (9% vs 1%, p <0.01), and higher incidence of chorioamnionitis (10% vs. 1%, p = 0.02) compared to the SoC group. In the NPWT group, 43% were exposed to a SSI reduction bundle compared to 3% in the SoC group. The incidence of SSI was 6% in NPWT women compared to 19% in SoC women. The incidence of wound complication was 13% in NPWT women compared to 22% in SoC women. (Table) After multivariable analysis, NPWT women had a lower risk of SSI compared to SoC women (adjusted OR 0.4, 95% CI 0.2 - 1.0). After adjustment, the risk of wound complications was not significant. In a cohort at high risk for postoperative infections due to morbid obesity, NPWT significantly reduces cesarean delivery surgical site infections.