Factors influencing anal sphincter injury risk ‘modifiable’

By Piriya Mahendra, medwireNews Reporter

Researchers have identified several modifiable risk factors significantly associated with wound complications after obstetric anal sphincter injuries (OASIS).

Smoking, increased body mass index (BMI), and fourth-degree laceration were associated with an increased incidence of wound complications after OASIS, at respective odds ratios (ORs) of 4.04, 1.06 (per 1 point BMI increase), and 1.89.

Operative vaginal delivery and postpartum antibiotics were also associated with post-OASIS wound complications, at ORs of 1.76 and 2.46. By contrast, the use of intrapartum antibiotics was protective, at an OR of 0.29.

Christina Lewicky-Gaupp (Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA) and team say that the results of the study may help them identify patients at risk for significant postpartum perineal morbidity.

"Modification of these factors may be critical in preventing the long-term consequences of wound infection and breakdown," they write in the American Journal of Obstetrics and Gynecology.

The retrospective chart review incorporated data on 909 women from the Northwestern University Medical Enterprise Data Warehouse. The majority of the cohort was Caucasian (71.3%) and nulliparous (92.8%). The mean age of the women was 31.8 years.

Wound complications occurred in 66 (7.3%) of the patients. Of these women, 39 (59.1%) had a documented wound infection, 36 (54.5%) had a breakdown of their wound, 17 (25.8%) required wound re-opening, and eight (12.1%) required wound packing.

Over 50% (34 of 66) of the wounds required operative intervention including debridement and 24 (36.4%) of these returned to the operating room for a secondary repair.

Multivariable binary logistic regression was used to construct a model to predict perineal wound complications that included smoking, BMI, laceration, vaginal delivery, and antibiotic use. The model correctly classified women at risk for wound complications after OASIS 92.9% of the time.

"Identification of these factors should influence how we follow our patients in the postpartum period as we try to prevent hospital readmission and operative interventions, as this is not only costly, but also places a significant burden on new mothers during an inherently stressful time," conclude the authors.

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