'Surgical Complications During Cesarean Delivery Linked to Postpartum Readmission Risk'

 Patients who experienced severe perioperative surgical morbidity during cesarean delivery had a higher risk for postpartum readmission within 42 days than those who did not, with wound infections being the most common reason for readmission.

METHODOLOGY:

• Researchers conducted a repeated cross-sectional study using linked data from birth certificates and hospital discharge records for 703,079 cesarean deliveries performed in California hospitals between October 2015 and 2021.
• Severe perioperative surgical morbidity was identified using codes for surgical complications during hospitalization for cesarean delivery. These complications included bowel injury, bladder or genitourinary injury, uterine injury, broad ligament hematoma, pelvic or retroperitoneal hematoma, hysterectomy, vascular injury, wound complications, ileus or bowel obstruction, and shock.
• The primary outcome was all-cause postpartum readmission within 42 days after hospital discharge. Readmission rates were quantified for patients with and without severe perioperative surgical morbidity.
• Secondary analysis assessed the association separately for prelabor and intrapartum cesarean deliveries.

TAKEAWAY:

• Overall, 9880 patients experienced severe perioperative surgical morbidity. Patients with severe perioperative surgical morbidity had a higher risk for readmission up to 42 days postpartum than those without such morbidity (adjusted relative risk [aRR], 2.22; 95% CI, 2.00-2.46).
• Severe perioperative surgical morbidity was associated with a similar risk for readmission in patients who underwent intrapartum cesarean delivery (aRR, 2.35; 95% CI, 2.09-2.65) and those who underwent cesarean delivery before labor (aRR, 2.03; 95% CI, 1.72-2.40).
• Patients experiencing shock, ileus or bowel obstruction, or hysterectomy during hospitalization for delivery had the highest frequencies of readmission (9.3%, 7.2%, and 5.2%, respectively). The most frequent diagnosis for readmission was infection of an obstetric wound.
• The median time from discharge to readmission was similar for patients with and without severe perioperative surgical morbidity.

IN PRACTICE:

“Findings suggest that the presence of severe perioperative surgical morbidity may be of use for identifying patients who would benefit from closer postpartum follow-up. Optimizing surgical wound care and interventions to reduce surgical site and genital tract infection may be important for reducing readmission risk among patients with severe perioperative surgical morbidity,” the authors wrote.

SOURCE:

This study was led by Alexander Butwick, MS, of the Department of Anesthesia and Perioperative Care at the University of California San Francisco. It was published online on May 15, 2026, in Obstetrics & Gynecology.

LIMITATIONS:

Protocols for enhanced recovery after cesarean are meant for uncomplicated deliveries and may not apply to patients with severe perioperative surgical morbidity. The surgical morbidities and reasons for readmission were identified using diagnosis codes, which might not always be accurate, so the true incidence of issues might not be clear. This study focused specifically on cesarean deliveries and readmission risk in California, which may limit how the findings apply to other states in the US.

DISCLOSURES:

Internal funding was provided by the Department of Anesthesia and Perioperative Medicine, University of California San Francisco. The authors reported having no relevant conflicts of interest.

https://www.medscape.com/viewarticle/surgical-complications-during-cesarean-delivery-linked-2026a1000i5s