Reoperation following cesarean birth: an analysis of incidence, indications, and procedures using a national surgical database.

Abstract

Objective: To determine the incidence of reoperation after uncomplicated cesarean birth, describe the types of procedures and indications for reoperation, and identify risk factors associated with reoperation using a national surgical database.

Study design: A retrospective cross-sectional study was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, encompassing data from January 1, 2019, to December 31, 2021. A total of 43,492 patients who underwent cesarean birth were included. Patients who underwent concurrent non-gynecologic procedures or hysterectomy were excluded. The primary outcomes measured were the incidence of unplanned reoperation within 30 days of cesarean birth, types of reoperative procedures, indications for reoperation, and associated risk factors. Statistical analyses included Student's t-test, Wilcoxon rank-sum test, Chi-squared test, and multivariable logistic regression.

Results: Out of 43,492 cesarean deliveries, 397 (0.9%) required unplanned reoperation. Significant risk factors for reoperation included 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). The most common indications for reoperation were postpartum hemorrhage (47%), wound disruption or infection (18%), and hematoma or hemoperitoneum (14%). The most frequently performed reoperative procedures were exploratory laparotomy without hysterectomy (27%), uterine curettage (23%), and wound debridement or drainage (22%).

Conclusion: Reoperation following cesarean birth is a relatively uncommon but significant event, occurring in 0.9% of cases. Key risk factors include smoking, hypertension, bleeding disorders, ASA class > 3, and concurrent myomectomy. This study provides comprehensive data on the clinical characteristics and indications for reoperation following cesarean birth in a diverse, multi-institutional U.S.

Cohort: The findings highlight the need for enhanced perioperative monitoring and targeted interventions for high-risk patients to improve maternal outcomes.