(1158) Incidence and risk factors associated with funisitis in patients with cesarean surgical site infections

Objective:
Surgical site infection (SSI) following cesarean confers significant maternal morbidity. Funisitis, acute inflammation of the umbilical cord, is a histologic finding of neutrophils within Wharton's jelly and is indicative of fetal inflammatory response. This study explores the relationship between funisitis and SSI, attempting to assess if funisitis can be used as a risk stratifying factor for wound complications.

Study Design:
IRB-approved retrospective cohort study of patients who delivered via cesarean and developed SSI at a single tertiary care facility between 4/1/2013 and 11/2/2019. Exposure of interest was histologic funisitis on pathologic analysis of the placenta. Demographic data, maternal history, intrapartum information, and wound infection details were abstracted from EMR. Primary outcome was factors associated with funisitis in the SSI population. Secondary analyses assessed rates of severe SSI (i.e. re-operation in OR), need for wound washout, debridement, readmission, and readmission complications (ICU, sepsis, etc.). Bivariate statistics analyzed the data. Regression models controlled for confounders.

Results:
618 patients met inclusion criteria, but placental pathology available in only 274 cases. The prevalence of funisitis was 23.0% (n=63). The primary outcome identified intraamniotic infection, cesarean in labor, and azithromycin administration as significantly associated with funisitis (Table1).

Patients with funisitis were more likely to require surgical management of SSI (31.7% vs 14.2%), wound washouts at bedside (20.6% vs 12.3%), management in hospital setting (84.1% vs 28.5%), and readmission (53.2% vs 28.5%) (all p< 0.05, Table 2). This remained true for all after controlling for confounders (Table 2).

Conclusion:
Funisitis is prevalent in patients who develop surgical site infections and is associated with more resource-heavy and complex wound management needs. Funisitis likely represents a more significant pathogen load in the intraamniotic cavity at the time of delivery. This information may help risk stratify patients at risk for cesarean wound complications.