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Hospital readmission after cesarean linked to extended operative time
Hospital readmission due to infection after cesarean delivery was linked to maternal age, BMI, operative time and membrane intactness, according to findings presented at the annual meeting of the American College of Obstetrics and Gynecology.
“Identifying risk factors for postpartum readmission due to infection may lead to prevention, early detection and treatment,” Tetsuya Kawakita, MD, of MedStar Washington Hospital Center and MedStar Georgetown University Hospital, told Healio Family Medicine.
Kawakita and colleagues conducted a retrospective study of 3,805 women at MedStar Washington Hospital Center who were at least 23 weeks gestation and undergoing a caesarean delivery. Readmission to the hospital due to infection after discharge, and up to 6 weeks postdelivery, was indicated if the patient developed endometritis, deep wound infection or other infections, including abdominopelvic abscess, maternal sepsis, pelvic septic thrombophlebitis, pyelonephritis, pneumonia or meningitis. Researchers compared maternal demographics and comorbidities as well as labor and delivery outcomes of mothers with vs without an infection-related hospital readmission.
Among the 3,805 women, 0.8% (n = 30) were readmitted to the hospital due to infection.
Kawakita and colleagues observed that a higher BMI at admission (adjusted OR = 1.05; 95% CI, 1.01-1.1), operative time of 60 minutes or more (aOR = 2.52; 95% CI, 1.13-5.58) and ruptured membrane (aOR = 3; 95% CI 1.17-7.68) increased the risk for hospital readmission due to an infection. Conversely, increasing maternal age was associated with a lower risk for hospital readmission due to infection (aOR = 0.93; 95% CI 0.87-0.996).
Kawakita said the finding that longer operative time increased the risk for postpartum readmission due to infection was surprising.
“ACOG recommends an additional dose of antibiotics if the operation is longer than 3 hours. However, based on our data, an additional dose of antibiotics may be indicated if the operative time is longer than 60 minutes,” Kawakitasaid in the interview. “A randomized controlled trial comparing an additional dose of antibiotics after 60 minutes to an additional dose of antibiotics after 3 hours may be useful.” - by Marley Ghizzone
Reference: Kawakita T, et al. Risk factors for readmission due to infection after cesarean delivery. Presented at: American College of Obstetricians and Gynecologists annual clinical and scientific meeting. April 27-30, 2018; Austin, Texas.
Disclosure: Kawakita reports not relevant financial disclosures. Please see the study for all other authors relevant financial disclosures.