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Am J Perinatol
DOI: 10.1055/a-2542-9318
SMFM Fellowship Series Article

Reoperation following Cesarean Birth: An Analysis of Incidence, Indications, and Procedures Using a National Surgical Database

Luke P. Burns
1   The University of Chicago Medicine, Chicago, Illinois
,
Jourdan E. Triebwasser
2   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
,
Christopher X. Hong
2   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
› Author Affiliations
Funding None.
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Abstract

Objective

This study aimed 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 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 nongynecologic procedures or hysterectomies 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 (adjusted odds ratio [aOR]: 1.96, 95% confidence interval [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), American Society of Anesthesiologists (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 US cohort. The findings highlight the need for enhanced perioperative monitoring and targeted interventions for high-risk patients to improve maternal outcomes.

Key Points

  • In this retrospective cross-sectional study of 43,492 cesarean deliveries, the incidence of unplanned reoperation was found to be 0.9%.

  • Significant risk factors for reoperation included smoking, hypertension, bleeding disorders, American Society of Anesthesiologists (ASA) class > 3, and concurrent myomectomy at the time of cesarean birth.

  • The most common indications for reoperation were postpartum hemorrhage, wound disruption or infection, and hematoma or hemoperitoneum.

  • The most common reoperative procedures were exploratory laparotomy without hysterectomy, uterine curettage, and wound debridement or drainage.

Keywords

cesarean birth - current procedural terminology (CPT) - dilation and curettage - hysterectomy - international classification of diseases (ICD) - laparotomy - NSQIP - postoperative complications - postpartum hemorrhage - reoperation - relaparotomy

Supplementary Material



Publication History

Received: 07 October 2024

Accepted: 19 February 2025

Accepted Manuscript online:
20 February 2025

Article published online:
18 March 2025

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