Postpartum Readmission after Unscheduled Cesarean Delivery in Patients with Class 3 Obesity.

Abstract

Objective:  This study aimed to identify risk factors for postpartum readmission (PPR) in class 3 obese patients undergoing unscheduled cesarean deliveries.

Study design:  Retrospective cohort study of patients with a body mass index (BMI) of ≥40 kg/m² undergoing unscheduled cesarean delivery from 2017 to 2020 comparing patients with and without PPR (unexpected admission, emergency room/overnight observation visit, unscheduled outpatient visit, or ambulatory surgery within 30 days). Medical history, operative data, and postpartum outcomes were compared between the cohorts.

Results:  The electronic medical record was queried to identify cesarean deliveries documented as "unscheduled." In total, 255 of 1,273 identified patients (20.0%) had a PPR. Median BMI was similar between the cohorts (44.2 kg/m², interquartile range [IQR]: [41.8, 47.9] vs. 44.8 kg/m² [42.0, 48.9], p = 0.066). Readmitted patients were more likely to have a history of smoking during or prior to pregnancy (p = 0.046). A subgroup exploratory analysis excluding outpatient and emergency room visits demonstrated higher rates of type II diabetes mellitus in patients with PPR (11.5 vs. 4.6%, p = 0.030). Patients with readmission in comparison to those without readmissions were less likely to receive cefazolin prophylaxis (78.0 vs. 84.3%, p = 0.014) in comparison to gentamicin/clindamycin prophylaxis. Patients with readmission were less likely to have had vaginal preparation (56.9 vs. 64.3%, p = 0.027). On multivariable logistic regression analysis, smoking history (odds ratio [OR] = 1.44, 95% confidence interval [CI]: 1.06-1.96, p = 0.0220) and hypertensive disease (OR = 1.57, 95% CI: 1.18-2.09, p = 0.002) were associated with readmission. Cefazolin preoperative prophylaxis (OR = 0.59, 95% CI: 0.41-0.84, p = 0.004) and vaginal sterile preparation (OR = 0.72, 95% CI: 0.54-0.95, p = 0.022) were associated with decreased risk of readmission.

Conclusion:  In class 3 obese patients, a history of smoking and a diagnosis of hypertensive disease are associated with an increased risk of PPR. Perioperative antibiotic prophylaxis with cefazolin along with vaginal sterile preparation associate with a decreased risk of PPR.

Key points: · Class 3 obesity and unscheduled cesarean deliveries are high risks for postpartum complications.. · Hypertensive disorders and smoking are associated with PPR.. · Cefazolin prophylaxis and vaginal preparation are associated with decreased PPR..