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Oral Concurrent Session 7 - Clinical Obstetrics & Postpartum

Oral Concurrent Sessions

(71) Reoperation following cesarean delivery: an analysis of incidence, indications, and procedures using a national database

Wednesday, February 14, 2024

4:30 PM – 4:45 PM

Location: Potomac Ballroom AB, Ballroom Level

Primary & Presenting Author(s)

Luke P. Burns, MD

MFM Fellow
University of Chicago Medicine
Chicago, Illinois, United States

Coauthor(s)

Jourdan E. Triebwasser, MD, MA (she/her/hers)

Assistant Professor of Obstetrics and Gynecology
University of Michigan
Ann Arbor, MI, United States
Christopher X. Hong, MD (he/him/his)

Urogynecology Fellow
University of Michigan
Ann Arbor, MI, United States

Objective: Prior studies have described reoperation rates after cesarean birth (CB) but primarily focus on relaparotomy and were conducted at single centers. The types of procedures and indications for reoperation in a more generalizable population remains unclear. Our objective was to determine the incidence of reoperation after uncomplicated CB, describe the types of procedures and indications for reoperation, and identify risk factors associated with reoperation using the National Surgical Quality Improvement Program (NSQIP) database.

Study Design: The NSQIP database was queried to identify patients who underwent CB between 2019-2021, based on International Classification of Diseases 10th Revision (ICD-10) codes. Cases involving non-gynecologic concurrent procedures or hysterectomy were excluded. Reoperations within 30 days of the CB were identified using Current Procedural Terminology (CPT) codes for the reoperation procedure and ICD-10 codes for the associated diagnosis. Patient characteristics were analyzed, and multivariable logistic regression models were used to identify risk factors associated with reoperation.

Results: A total of 43,113 CB were analyzed, among which 397 (0.88%) required reoperation. Out of these, 330 (87%) reoperations were performed for indications associated with the CB. Postpartum hemorrhage was the most common diagnosis for reoperation (47%), followed by wound disruption or infection (18%), and hematoma or hemoperitoneum (14%). The main types of reoperation included exploratory laparotomy without hysterectomy (27%), uterine curettage (23%), and wound debridement and drainage (22%). In the final multivariable model, several risk factors were independently associated with a higher likelihood of reoperation: smoking (aOR 1.96, 95% CI 1.49-1.56), hypertension (aOR 1.83, 95% CI 1.27-2.62), bleeding disorders (aOR 2.11, 95% CI 1.15-3.89), ASA) class >3 (aOR 2.23, 95% CI 1.29-3.84), and concurrent myomectomy (aOR 4.39, 95% CI 1.06-18.2).

Conclusion: Reoperation after cesarean birth is uncommon but associated with identifiable perioperative risk factors.