ORCID Identifier(s)

0000-0003-0402-5988

Graduation Semester and Year

2017

Language

English

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Nursing

Department

Nursing

First Advisor

Joy Don Baker

Abstract

The purpose of this study was to evaluate trends in the incidence of serious infectious events (SIE), defined as organ space infection, sepsis, and Cesarean Section (CS) wound disruption, during the birth admission or resulting in between January 1, 2009 and December 31, 2014 in the State of Texas. A retrospective analysis of the Public Use Data File, maintained by the Texas Health Care Information Collection was conducted. Records of 627,555 women who had CS and 1,023 women readmitted for CS wound disruption, were included. During the study period, there was a large decrease in the rate at which SIE occurred (R2=.59). This was potentially influenced by a large decrease in the rate of the diagnosis of endometritis (R2=.41). Decreases in the diagnosis of and readmission for CS wound disruption were not as large (R2=.06; R2=.03). A large increase in the diagnosis of sepsis (R2=.32) among women who gave birth by CS was identified. Characteristics of women associated with increased odds of developing SIE included being age 19 years and under, Black race. Treatment exposures; internal fetal monitoring, and induction of labor were associated with increased odds of SIE. Comorbid conditions that increased the odds of being diagnosed with SIE included chorioamnionitis, anemia, post term pregnancy, severe pre-eclampsia, obesity, diabetes, early onset of labor, and abnormal fetal heart rate. The odds of being diagnosed with cellulitis and abscess of the trunk were highly increased among women diagnosed with a SIE. Women who gave birth at facilities located in rural counties had lower odds of being diagnosed with a SIE; women who gave birth by CS at teaching facilities had increased odds of being diagnosed with a SIE. No conclusions about pathogens could be drawn.

Keywords

Cesarean Section, Infection

Disciplines

Medicine and Health Sciences | Nursing

Comments

Degree granted by The University of Texas at Arlington

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