Association of smoking with wound complications after cesarean delivery

Objective: To determine whether smoking is an independent risk factor for wound dehiscence after cesarean delivery. Methods: In this case-control study, medical records were reviewed for all patients with wound dehiscence after cesarean delivery during a 7-month period. Wound dehiscence was defined as separation of wound edges requiring treatment. Three control patients without such complications were randomly selected for each case patient. Univariate associations were assessed using t test or Fisher's exact test; univariate odds ratios (OR) and 95% confidence intervals (CI) were calculated with logistic regression. Multivariate associations were assessed with logistic regression on variables with a univariate association significant at p ≤ 0.10. Results: Of 597 cesarean deliveries, 30 cases (5 %) with wound dehiscence were identified. As individual variables, smoking (46.7 vs. 21.1%, p < 0.01, cases vs. controls), histological chorioamnionitis (27.6 vs. 6.7%, p < 0.01) and preoperative hematocrit (34.0 ± 3.2 vs. 35.4 ± 3.4, p < 0.05) were significantly associated with wound complications. In a multivariate logistic regression model, only smoking (OR 5.32; 95% CI 1.77-15.97, p < 0.01) and histological chorioamnionitis (OR 5.62; 95% CI 1.43-22.11, p < 0.01) were independently associated with wound dehiscence. Conclusions: Smoking and histological chorioamnionitis are independently associated with wound dehiscence after cesarean delivery.