(684) Impact of a surgical bundle on hospital readmission rates in obese women undergoing cesarean delivery.

To assess whether implementing an obesity surgical bundle for patients with a BMI of 40 kg/m² or greater reduces hospital readmission rates after unscheduled cesarean delivery.

Study Design:

This was a pre- and post-intervention study of individuals with a BMI > 40 kg/m² undergoing unscheduled cesarean delivery at 24 weeks of gestation or greater between January 2018 and December 2022 at a single tertiary care center. In January of 2021, we implemented an obesity bundle that included vaginal preparation with povidone-iodine in the setting of ruptured membranes, and a 48-hour course of oral cephalexin and metronidazole. Our primary outcome was hospital readmission or emergency department visits within 6 weeks postpartum. We also examined the rate of hospital readmission alone. Relative risks with 95% confidence intervals (95% CI) were calculated using modified Poisson regression, adjusting for potential confounders.

Results:

Of 1823 individuals who underwent unscheduled cesarean, 980 (54%) were in the pre-intervention period and 843 (46%) in the post-intervention period. Maternal demographics were overall similar, except for lower gestational age at delivery in the post-intervention period (Table 1). Compared to the pre-intervention period, the rate of hospital readmission or emergency department visits was significantly lower in the post-intervention period (35.0% vs. 28.7%, aRR 0.82 95%CI 0.72-0.94, P < 0.01). Hospital readmission alone was also significantly lower in the post-intervention period (33.0% vs. 26.2%, aRR 0.80 95%CI 0.69-0.92 , P < 0.01) (Table 2).

Conclusion:

The rate of hospital readmissions and emergency department visits decreased significantly after the implementation of a surgical bundle for individuals with a BMI greater than 40 kg/m² undergoing cesarean delivery.