Strengths and Limitations
This study used BMI to diagnose obesity and the accuracy of BMI has been questioned; Romero-Corral et al. 53 found that the use of BMI to diagnose obesity was not completely accurate, especially in those individuals with a BMI <30 kg/m2 with 12% of women being misclassified as being obese (Romero-Corral et al. 2008). However, BMI ≥ 30 kg/m2 has greater specificity for females in general due to the greater correlation with body fat percentage compared to males. Indeed, BMI remains one of the most commonly used methods to calculate body composition.
This study utilised data collected from a single hospital in a single NHS Trust and a relatively small sample size may have contributed to the finding that certain patient-related factors were not associated with an increased risk of SSI following CS. It was also difficult to capture data on certain variables due to missing or inaccurate data recording. In addition, the identification of patients with SSIs relied on wound swabs. Use of swabs to identify an infection can lead to both false negative results (due to decreased volume of bacteria collected by the swab, as identified by Aggarwal et al. 54; and false positive results (when the swab becomes contaminated by commensal organisms). However, alternatives such as the use of tissue cultures to increase sensitivity and specificity would be more invasive for the patient therefore swabs were considered the most accurate method of identifying infection in this study.