Postdischarge Surveillance After Cesarean Section

Background: Cesarean section is a major surgical procedure with a relatively short hospital stay. A significant rate of surgical site infection after this procedure is missed by standard inpatient surveillance. This study aimed to evaluate a method of postdischarge surveillance and compare results with the incidence of infection before discharge. Method: A postdischarge survey was sent on day 30 to 277 women who had delivered by cesarean section during the 12‐month study period. A follow‐up telephone interview was conducted if the questionnaire had not been returned within 2 weeks, if a diagnosis of infection could not be clearly determined from the participant's responses, or to confirm the diagnosis of infection. If follow‐up was not completed, a chart audit was undertaken. Results: A total response rate of 89 percent (247/277) was obtained, and 28 women with a surgical site infection were identified from the survey. Telephone follow‐up and chart review of patients with possible infection and of nonresponders identified 32 percent more postdischarge infections (14/42). The overall infection rate was 17 percent compared with 2.8 percent at discharge. Conclusions: Postdischarge surveillance is necessary to determine accurate surgical site infection rates after cesarean section, increase awareness of caregivers about infection control problems, and indicate the need for appropriate follow‐up care. Women undergoing a cesarean delivery should be informed of the risk of postdischarge infection and educated about the signs and symptoms of infection.     

Postoperative spontaneous pneumoperitoneum

A case of spontaneous pneumoperitoneum (the sixth) is reported. This is similar to four of the other cases in which there is an accompanying chest condition. This case is unusual in that it followed an operative procedure with opening of the peritoneum but at such a late date that there could be no connection between this and the pathological condition present. It also parallels the picture of tension pneumothorax in that the condition became worse and also was relieved only by removal of the air. The presence of a connection between the bronchial tree and the peritoneum seems necessary, in view of the fact that at no time either before or after the operation were there any symptoms referable to the gastrointestinal tract. Also, as is seen in tension pneumothorax, the release of the air resulted in a breaking of the vicious cycle and spontaneous recovery. Subsidence occurred spontaneously after removal of part of the air.