In the Journals

Cesarean delivery infection risk higher in women insured by Medicaid

Medicaid-insured women experience a higher risk for surgical site infection following cesarean delivery than privately insured women, according to study findings.

Writing in Infection Control & Hospital Epidemiology, CDC researcher Sarah H. Yi, PhD, and colleagues noted that one-third of births in the United States occur by cesarean delivery.

“Although lifesaving in some circumstances, cesarean deliveries also confer risks for adverse maternal outcomes such as surgical site infection (SSI), including endometritis and wound infection,” they wrote.

“Cesarean delivery is one of the most common inpatient surgical procedures in the United States, which heightens the importance of developing effective interventions and prevention strategies to lower the risk of complications following Cesarean delivery. Previous studies have identified patient- and procedure-level risk factors that can be successfully targeted in SSI prevention efforts; however, the role of socioeconomic and health care system determinants of post-cesarean delivery SSI risk is incompletely understood.”

To compare the risk for SSI after cesarean delivery between women covered by Medicaid and private health insurance, Yi and colleagues performed a retrospective cohort study examining cesarean deliveries reported to the National Healthcare Safety Network and state inpatient discharge databases by hospitals in California between 2011 and 2013.

According to the study, of the 291,757 cesarean deliveries included, 48% were covered by Medicaid. Results showed 1,055 deliveries (0.75%) covered by Medicaid resulted in SSIs compared with 955 deliveries (0.63%) covered by private insurance (adjusted OR = 1.4; 95% CI, 1.2 to 1.6; P < .0001).

Additionally, Yi and colleagues found that SSIs were more often detected during post-discharge surveillance and hospital readmission than index hospitalization, accounting for 0.36%, and 0.28% of cesarean deliveries, respectively. Results showed that Medicaid-insured women had higher adjusted risks of SSI in both detection periods (OR = 1.4; 95% CI, 1.2 to 1.7, P < .0001).

“In this largest and only multicenter study of SSI risk following cesarean delivery by primary payer, Medicaid-insured women had a higher risk of SSIs than privately insured women,” the authors concluded. “These findings suggest the need to evaluate and better characterize maternal health care as delivered to women covered by Medicaid. Such information can inform targeted infection prevention efforts by hospitals serving vulnerable patient groups.” – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.

Medicaid-insured women experience a higher risk for surgical site infection following cesarean delivery than privately insured women, according to study findings.

Writing in Infection Control & Hospital Epidemiology, CDC researcher Sarah H. Yi, PhD, and colleagues noted that one-third of births in the United States occur by cesarean delivery.

“Although lifesaving in some circumstances, cesarean deliveries also confer risks for adverse maternal outcomes such as surgical site infection (SSI), including endometritis and wound infection,” they wrote.

“Cesarean delivery is one of the most common inpatient surgical procedures in the United States, which heightens the importance of developing effective interventions and prevention strategies to lower the risk of complications following Cesarean delivery. Previous studies have identified patient- and procedure-level risk factors that can be successfully targeted in SSI prevention efforts; however, the role of socioeconomic and health care system determinants of post-cesarean delivery SSI risk is incompletely understood.”

To compare the risk for SSI after cesarean delivery between women covered by Medicaid and private health insurance, Yi and colleagues performed a retrospective cohort study examining cesarean deliveries reported to the National Healthcare Safety Network and state inpatient discharge databases by hospitals in California between 2011 and 2013.

According to the study, of the 291,757 cesarean deliveries included, 48% were covered by Medicaid. Results showed 1,055 deliveries (0.75%) covered by Medicaid resulted in SSIs compared with 955 deliveries (0.63%) covered by private insurance (adjusted OR = 1.4; 95% CI, 1.2 to 1.6; P < .0001).

Additionally, Yi and colleagues found that SSIs were more often detected during post-discharge surveillance and hospital readmission than index hospitalization, accounting for 0.36%, and 0.28% of cesarean deliveries, respectively. Results showed that Medicaid-insured women had higher adjusted risks of SSI in both detection periods (OR = 1.4; 95% CI, 1.2 to 1.7, P < .0001).

“In this largest and only multicenter study of SSI risk following cesarean delivery by primary payer, Medicaid-insured women had a higher risk of SSIs than privately insured women,” the authors concluded. “These findings suggest the need to evaluate and better characterize maternal health care as delivered to women covered by Medicaid. Such information can inform targeted infection prevention efforts by hospitals serving vulnerable patient groups.” – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.