Complications and costs associated with adhesiolysis at the time of repeat cesarean delivery

Abstract

OBJECTIVE: To calculate the proportion of women with adhesiolysis at primary or repeat Cesarean delivery (CD) and to compare rates of bleeding complications, postoperative length of stay (LOS), and total hospital costs in patients with and without adhesiolysis at repeat CD.DESIGN: A propensity score–matched cohort study.MATERIALS AND METHODS: Data from a sample of 609 US hospitals were used to identify women with either primary or repeat CD. We included women ≥15 years old, with singleton gestation, and discharged in calendar years 2007 or 2008. Adhesiolysis rates were calculated for primary and repeat CD. For repeat CD, propensity score matching was used to achieve comparability on patient, hospital, and physician characteristics between adhesiolysis and control groups. We evaluated risk for bleeding complications and mean postoperative LOS and total hospital costs between groups.RESULTS: Of 223,129 primary and 166,980 repeat CD women included, adhesiolysis was performed in 0.5% (n=1,056) and 6.1% (n=10,262), respectively. Using propensity scores, 10,261 repeat CD women with adhesiolysis were matched to 10,261 controls without adhesiolysis; cohorts were comparable. Hemorrhage occurred in 1.7% (n=178) of the adhesiolysis group and 1.2% (n=121) of controls; relative risk (RR) =1.47, 95% CI = 1.17-1.85. Transfusion was required in 1.9% (n=194) of the adhesiolysis group and 1.1% (n=108) of controls; RR = 1.80, (1.42-2.27). The adhesiolysis group had greater LOS (3.0 ± 0.9 vs. 2.9 ± 0.8 days; P<0.001) and higher total hospital costs ($5,739 ± 3,368 vs. $5,448 ± 3,031; P <0.001) compared with controls.CONCLUSION: Adhesiolysis rates were significantly higher at the time of repeat compared with primary CD. At repeat CD, the risk of complications was higher in patients who had adhesiolysis than in those who did not. Measures to prevent adhesions taken during first CD may reduce complications and overall hospital costs at the time of repeat CD. OBJECTIVE: To calculate the proportion of women with adhesiolysis at primary or repeat Cesarean delivery (CD) and to compare rates of bleeding complications, postoperative length of stay (LOS), and total hospital costs in patients with and without adhesiolysis at repeat CD. DESIGN: A propensity score–matched cohort study. MATERIALS AND METHODS: Data from a sample of 609 US hospitals were used to identify women with either primary or repeat CD. We included women ≥15 years old, with singleton gestation, and discharged in calendar years 2007 or 2008. Adhesiolysis rates were calculated for primary and repeat CD. For repeat CD, propensity score matching was used to achieve comparability on patient, hospital, and physician characteristics between adhesiolysis and control groups. We evaluated risk for bleeding complications and mean postoperative LOS and total hospital costs between groups. RESULTS: Of 223,129 primary and 166,980 repeat CD women included, adhesiolysis was performed in 0.5% (n=1,056) and 6.1% (n=10,262), respectively. Using propensity scores, 10,261 repeat CD women with adhesiolysis were matched to 10,261 controls without adhesiolysis; cohorts were comparable. Hemorrhage occurred in 1.7% (n=178) of the adhesiolysis group and 1.2% (n=121) of controls; relative risk (RR) =1.47, 95% CI = 1.17-1.85. Transfusion was required in 1.9% (n=194) of the adhesiolysis group and 1.1% (n=108) of controls; RR = 1.80, (1.42-2.27). The adhesiolysis group had greater LOS (3.0 ± 0.9 vs. 2.9 ± 0.8 days; P<0.001) and higher total hospital costs ($5,739 ± 3,368 vs. $5,448 ± 3,031; P <0.001) compared with controls. CONCLUSION: Adhesiolysis rates were significantly higher at the time of repeat compared with primary CD. At repeat CD, the risk of complications was higher in patients who had adhesiolysis than in those who did not. Measures to prevent adhesions taken during first CD may reduce complications and overall hospital costs at the time of repeat CD.