Burden and associated factors of surgical site infection following caesarean section in a Nigerian tertiary hospital: a retrospective cohort study

Surgical site infection following caesarean section is a significant cause of maternal morbidity and mortality, particularly in low- and middle-income countries. Understanding the local burden and associated risk factors is crucial for developing effective prevention strategies. This study aimed to estimate the incidence and identify factors associated with surgical site infection post-caesarean section at a Nigerian tertiary hospital. A retrospective cohort study was conducted reviewing records of all women who underwent caesarean section at Lagos State University Teaching Hospital from January 2018 to December 2022. Surgical site infection was diagnosed and classified using Centres for Disease Control and Prevention criteria within a 30-day post-operative period. Bivariate analysis and multivariable binary logistic regression were performed to identify factors associated with surgical site infection. Among 491 women included in the study, 70 developed surgical site infection, giving a documented incidence of 14.3%. All participants were classified as overweight (53.4%) or obese (46.6%) no participants were underweight or of normal weight. All identified infections were superficial or deep incisional surgical site infection; no organ/space surgical site infection was recorded. On multivariable logistic regression, booking weight was the only independent factor associated with SSI, with higher booking weight associated with lower odds of infection (aOR 0.96, 95% CI 0.93–0.99; p = 0.009). The burden of post-caesarean surgical site infection in our setting is substantial, exceeding global averages. Lower maternal booking weight is an independent predictor of surgical site infection following caesarean section in this overweight and obese cohort. However, this observational finding does not establish a causal pathway, and booking weight in this population should not be interpreted as a proxy for malnutrition. The potential clinical utility of pre-pregnancy weight optimization or targeted perioperative interventions in this population remains to be determined and warrants investigation in prospective clinical trials. Not applicable.