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Poster Session 1

(274) Organ injury during primary and repeat cesarean: cross sectional analysis from the National Inpatient Sample

Thursday, January 30, 2025
10:30 AM – 12:30 PM  

    Submitting Author and Presenting Author(s)

  • Margarita Berwick, BA, BS, MD

    Academic Hospitalist
    Orlando Health Winnie Palmer Hospital for Women and Babies
    Orlando Health Winnie Palmer Hospital for Women & Babies, Florida, United States

    • Coauthor(s)

  • CG

    Cyndi Garvan, PhD

    Professor
    University of Florida College of Medicine
    Gainesville, Florida, United States

  • TW

    Ting Wu, DO

    Orlando Health Winnie Palmer Hospital for Women & Babies
    Orlando Health Winnie Palmer Hospital for Women & Babies, Florida, United States

  • RE

    Rodney Edwards, MD, MS

    University of Florida College of Medicine
    Gainesville, Florida, United States

Objective: The incidence of cesarean delivery in the United States is rising. The objective of the present study is to present contemporary nationally-representative data regarding incidence of organ injury and hysterectomy during primary and repeat cesarean deliveries.

Study Design: We conducted a cross-sectional and weighted analysis of delivery admissions included in the National Inpatient Sample from 2019 to 2021. Any organ damage was defined as damage to the bladder, ureter, small bowel, or large bowel. We tested group differences using chi-square and Wilcoxon rank sum tests. We used logistic modeling to compare risk of any organ injury in primary versus repeat cesarean with adjustment for covariates of age, race, income, and year of delivery.

Results:

Of the 673,525 cesarean deliveries in the dataset, most (52%) were primary cesareans. Rates of injury and unadjusted odds ratios in primary and repeat cesareans are shown in Table 1.  After adjusting for age, race, income and year of delivery, compared to primary cesareans, those undergoing repeat cesarean had adjusted odds (95% CI) of any organ damage of 3.54 (3.13, 4.02), bladder repair of 4.17 (3.62,4.79), ureter repair of 1.65 (0.28, 9.86), small bowel repair of 1.99  (1.36,2.83), large bowel repair of 0.79 (0.45,1.39) and hysterectomy of 1.63 (1.38,1.92).

Conclusion: Rates of any organ injury, bladder repair, small bowel repair, and hysterectomy, but not ureteral repair or large bowel repair, are higher in repeat compared to primary cesarean deliveries. However, although organ injuries during primary cesarean are less frequent than those in repeat cases, thousands occur annually in the US due to the large number of cesarean deliveries each year.