(984) Racial and Ethnic Differences in Delivery Characteristics in Patients with a Cesarean Wound Infection

Friday, January 31, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Carmen Rauh Garrido, MS (she/her/hers)

Duke School of Medicine
Durham, North Carolina, United States

Coauthor(s)

Rachel L. Wood, MD (she/her/hers)

Assistant Professor
Duke University
Durham, North Carolina, United States
Sarah K. Dotters-Katz, MD

Associate Professor
Duke University School of Medicine
Durham, North Carolina, United States
JW

Janice Wong, MD

Duke University School of Medicine
Durham, North Carolina, United States

Objective: Black race and Hispanic ethnicity have been identified as risk factors for cesarean wound infection. This likely represents systemic bias, as there is no biological explanation for these differences. This study sought to identify differences among self-reported racial and ethnic groups in delivery or postpartum factors that could be targeted to lessen disparities.

Study Design: This was an IRB-approved, retrospective cohort study of patients with post-cesarean wound infections requiring an emergency department or triage wound-related visit from a single healthcare system between 6/1/2013-7/31/2022, excluding patients with placenta accreta or severe preeclampsia. Primary exposure was self-reported race and ethnicity. Outcomes of interest were delivery characteristics predisposing to wound infection (GBS status, cesarean operative time, antibiotics received, estimated blood loss, skin closure with staples, peripartum infection). Bivariate statistics were used to analyze data. Regression models developed to control for confounders.

Results: Of 533 patients with post-cesarean wound infections, 180(33.7%) identified as non-Hispanic Black(NHB), 233(43.7%) non-Hispanic White(NHW), and 80(15.0%) as Hispanic. NHB and Hispanic patients had a significantly higher BMI and were more likely to have public insurance than NHW patients. NHB patients were more likely to use tobacco than NHW patients(Table 1). Hispanic patients had a higher rate of PP endometritis treatment(n=16,8.7%), compared to NHW(n=7,3.0%), and NHB(n=3,3.8%). In regression models, NHB patients were significantly more likely to be GBS positive(OR 1.70 (1.01,2.85)) and were more likely to be diagnosed in triage(OR 1.51 (0.98, 2.33)), though this finding was not statistically significant(Table 2).

Conclusion: Among patients with wound infections after cesarean, PP endometritis, GBS, and diagnosis location differed, yet no modifiable delivery characteristics were noted among racial and ethnic groups. Future research may investigate disparities in peripartum infection as a risk factor for wound infection and differences in postpartum healthcare access.