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.