Incidence and influencing factors for surgical site infections after cesarean section in China: A systematic review and meta-analysis

Objective: This study aims to estimate the overall incidence of surgical site infections (SSIs) after cesarean section (CS) and the influencing factors in the Chinese population. Materials and Methods: The study searched all relevant literature in English and Chinese search databases (English search bases: PubMed, Embase, Cochrane Library, Web of Science; Chinese search bases: China National Knowledge Infrastructure, Wanfang, and China Science and Technology Journal Database) up to March 19, 2024, according to the search strategy. A random/fixed effects model was decided on the basis of the I2 statistic assessing the magnitude of study heterogeneity, and publication bias was assessed using the Begg's test. Results: After the selection, a final selection of 25 articles was involved. The estimate of post-CS SSIs in China was 2.4% (95%CI: 0.019, 0.029). Age >= 30 years (WMD: 3.8), pre-pregnancy body mass index (BMI) >= 25 kg/m(2) (WMD: 1.8), obesity (odds ratio [OR]: 3.0), vaginal cleanliness 3-4 (OR: 4.2), anemia (OR: 1.4), premature rupture of membranes (OR: 2.6), diabetes mellitus (OR: 2.7), National Nosocomial Infections Surveillance System 1-3 (OR: 5.6), emergency surgery (OR: 2.3), trial of labor (OR: 2.9), duration of surgery >= 60 min (OR: 2.0), and intraoperative blood loss >500 mL (OR: 3.5) were the risk factors for post-CS SSIs. Conclusions: The rate of post-CS SSIs estimated was 2.4% in China. Both maternal conditions and surgical factors can potentially increase the risk of post-CS SSIs.