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Am J Perinatol 2025; 42(07): 933-940
DOI: 10.1055/a-2445-3123
Original Article

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

Surabhi Tewari 
1   Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio
2   Department of Obstetrics and Gynecology, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, Massachusetts
,
Meng Yao
3   Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
,
Lydia DeAngelo
1   Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio
,
Victoria Rogness
1   Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio
,
Lauren Buckley
4   Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
,
Swapna Kollikonda
4   Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
,
Oluwatosin Goje
4   Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
,
Maeve Hopkins 
4   Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
5   Department of Maternal-Fetal Medicine, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations Funding None.
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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.

Keywords

obesity - cesarean - readmission - hypertension - diabetes - infection - antibiotics

Note

Findings were presented at the 43rd Annual Pregnancy Meeting held by the Society of Maternal-Fetal Medicine in San Francisco, CA, February 6–11, 2023.




Publication History

Received: 02 March 2024

Accepted: 17 October 2024

Accepted Manuscript online:
18 October 2024

Article published online:
26 November 2024

© 2024. Thieme. All rights reserved.

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