Hostname: page-component-848d4c4894-nr4z6 Total loading time: 0 Render date: 2024-06-11T07:01:08.591Z Has data issue: false hasContentIssue false
  • English
  • Français

Surgical site infection risk following cesarean deliveries covered by Medicaid or private insurance

Published online by Cambridge University Press:  09 April 2019

Sarah H. Yi Open the ORCID record for Sarah H. Yi [Opens in a new window] ,
Kiran M. Perkins ,
Sophia V. Kazakova Open the ORCID record for Sophia V. Kazakova [Opens in a new window] ,
Kelly M. Hatfield ,
David G. Kleinbaum Open the ORCID record for David G. Kleinbaum [Opens in a new window] ,
James Baggs Open the ORCID record for James Baggs [Opens in a new window] ,
Rachel B. Slayton Open the ORCID record for Rachel B. Slayton [Opens in a new window]  and
John A. Jernigan
Sarah H. Yi*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Kiran M. Perkins
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Sophia V. Kazakova
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Kelly M. Hatfield
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
David G. Kleinbaum
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, Georgia
James Baggs
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Rachel B. Slayton
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
John A. Jernigan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Author for correspondence: Sarah H. Yi, Email: sarahyi@cdc.gov
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To compare risk of surgical site infection (SSI) following cesarean delivery between women covered by Medicaid and private health insurance.

Study design:

Retrospective cohort.

Study population:

Cesarean deliveries covered by Medicaid or private insurance and reported to the National Healthcare Safety Network (NHSN) and state inpatient discharge databases by hospitals in California (2011–2013).

Methods:

Deliveries reported to NHSN and state inpatient discharge databases were linked to identify SSIs in the 30 days following cesarean delivery, primary payer, and patient and procedure characteristics. Additional hospital-level characteristics were obtained from public databases. Relative risk of SSI by primary payer primary payer was assessed using multivariable logistic regression adjusting for patient, procedure, and hospital characteristics, accounting for facility-level clustering.

Results:

Of 291,757 cesarean deliveries included, 48% were covered by Medicaid. SSIs were detected following 1,055 deliveries covered by Medicaid (0.75%) and 955 deliveries covered by private insurance (0.63%) (unadjusted odds ratio, 1.2; 95% confidence interval [CI], 1.1–1.3; P < .0001). The adjusted odds of SSI following cesarean deliveries covered by Medicaid was 1.4 (95% CI, 1.2–1.6; P < .0001) times the odds of those covered by private insurance.

Conclusions:

In this, the largest and only multicenter study to investigate SSI risk following cesarean delivery by primary payer, Medicaid-insured women had a higher risk of infection than privately insured women. These findings suggest the need to evaluate and better characterize the quality of maternal healthcare for and needs of women covered by Medicaid to inform targeted infection prevention and policy.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 6 , June 2019 , pp. 639 - 648
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: These findings were presented in part at IDWeek 2015 on October 8, 2015, in San Diego, California, and at IDWeek 2017 on October 7, 2017, in San Diego, California.

References

Martin, JA, Hamilton, BE, Osterman, MJ, Driscoll, AK, Mathews, TJ. Births: final data for 2015. Natl Vital Stat Rep 2017;66:1.Google ScholarPubMed
Barber, EL, Lundsberg, LS, Belanger, K, Pettker, CM, Funai, EF, Illuzzi, JL. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol 2011;118:29–38.CrossRefGoogle ScholarPubMed
Declercq, E, Barger, M, Cabral, HJ, et al. Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstet Gynecol 2007;109:669–677.CrossRefGoogle ScholarPubMed
Clapp, MA, Little, SE, Zheng, J, Robinson, JN. A multi-state analysis of postpartum readmissions in the United States. Am J Obstet Gynecol 2016;215:e111–e113.CrossRefGoogle ScholarPubMed
McDermott, KW, Freeman, WJ, Elixhauser, A. Overview of operating room procedures during inpatient stays in US hospitals, 2014: statistical brief #233. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: AHRQ; 2017. www.hcupus.ahrq.gov/reports/statbriefs/sb233-Operating-Room-Procedures-United-States-2014.pdf. Accessed March 21, 2019.Google ScholarPubMed
Carter, EB, Temming, LA, Fowler, S, et al. Evidence-based bundles and cesarean delivery surgical site infections: a systematic review and meta-analysis. Obstet Gynecol 2017;130:735–746.CrossRefGoogle ScholarPubMed
Olsen, MA, Butler, AM, Willers, DM, Gross, GA, Devkota, P, Fraser, VJ. Risk factors for endometritis after low transverse cesarean delivery. Infect Control Hosp Epidemiol 2010;31:69–77.CrossRefGoogle ScholarPubMed
Shree, R, Park, SY, Beigi, RH, Dunn, SL, Krans, EE. Surgical site infection following cesarean delivery: patient, provider, and procedure-specific risk factors. Am J Perinatol 2016;33:157–164.CrossRefGoogle ScholarPubMed
Weighted national estimates from Healthcare Cost and Utilization Project National Inpatient Sample, 2014. Agency for Healthcare Research and Quality website. http://hcupnet.ahrq.gov. Published 2014. Accessed October 26, 2018.Google Scholar
National Healthcare Safety Network. Procedure-associated module: surgical site infection (SSI) event. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed September 15, 2015.Google Scholar
Patient discharge data 2010-2014 data dictionary, nonpublic files. California Office of Statewide Health Planning and Development website. https://www.oshpd.ca.gov/documents/HID/Data_Request_Center/DataDictionary_Nonpublic_PDD.pdf. Published July 6, 2015. Accessed March 11, 2019.Google Scholar
Statewide Planning and Research Cooperative System. Inpatient output data element dictionary, version 1.0. New York Health Department website. https://www.health.ny.gov/statistics/sparcs/sysdoc/inpatientoutputdd.pdf. Published April 2014. Accessed March 11, 2019.Google Scholar
NHSN Standardized Infection Ratio (SIR): a guide to the SIR. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/nhsn-sir-guide.pdf. Accessed June 19, 2018.Google Scholar
Mu, Y, Edwards, JR, Horan, TC, Berrios-Torres, SI, Fridkin, SK. Improving risk-adjusted measures of surgical site infection for the National Healthcare Safety Network. Infect Control Hosp Epidemiol 2011;32:970–986.CrossRefGoogle ScholarPubMed
National Health and Nutrition Examination Survey. 2011-2012 Data documentation, codebook, and frequencies: body measures. Centers for Disease Control and Prevention website. https://wwwn.cdc.gov/Nchs/Nhanes/2011-2012/BMX_G.htm#BMXHT. Accessed June 25, 2018.Google Scholar
Alanis, MC, Villers, MS, Law, TL, Steadman, EM, Robinson, CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol 2010;203(3):e271–e277.CrossRefGoogle ScholarPubMed
Wloch, C, Wilson, J, Lamagni, T, Harrington, P, Charlett, A, Sheridan, E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. BJOG 2012;119:1324–1333.CrossRefGoogle ScholarPubMed
Ketcheson, F, Woolcott, C, Allen, V, Langley, JM. Risk factors for surgical site infection following cesarean delivery: a retrospective cohort study. CMAJ Open 2017;5(3):E546–E556.CrossRefGoogle ScholarPubMed
Olsen, MA, Butler, AM, Willers, DM, Devkota, P, Gross, GA, Fraser, VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol 2008;29:477–484.CrossRefGoogle ScholarPubMed
Leth, RA, Uldbjerg, N, Norgaard, M, Moller, JK, Thomsen, RW. Obesity, diabetes, and the risk of infections diagnosed in hospital and post-discharge infections after cesarean section: a prospective cohort study. Acta Obstet Gynecol Scand 2011;90:501–509.CrossRefGoogle ScholarPubMed
Krieger, Y, Walfisch, A, Sheiner, E. Surgical site infection following cesarean deliveries: trends and risk factors. J Matern Fetal Neonatal Med 2017;30:8–12.CrossRefGoogle ScholarPubMed
Killian, CA, Graffunder, EM, Vinciguerra, TJ, Venezia, RA. Risk factors for surgical-site infections following cesarean section. Infect Control Hosp Epidemiol 2001;22:613–617.CrossRefGoogle ScholarPubMed
Gagne, JJ, Glynn, RJ, Avorn, J, Levin, R, Schneeweiss, S. A combined comorbidity score predicted mortality in elderly patients better than existing scores. J Clin Epidemiol 2011;64:749–759.CrossRefGoogle ScholarPubMed
Instructions for completion of the patient safety component-annual hospital survey (CDC 57.103). Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/forms/instr/57_103-TOI.pdf. Accessed December 7, 2017.Google Scholar
Acute inpatient prospective payment system wage index data files. Centers for Medicare & Medicaid website. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/wageindex.html. Accessed July 26, 2018.Google Scholar
Diagnosis-related group (DRG) weight data. National Bureau of Economic Research website. http://www.nber.org/data/drg.html. Accessed August 16, 2017.Google Scholar
Kleinbaum, DG, Klein, M, Pryor, ER. Logistic Regression: A Self-Learning Text, 2nd ed. New York: Springer; 2002.Google Scholar
Yee, LM, Kamel, LA, Quader, Z, et al. Characterizing literacy and cognitive function during pregnancy and postpartum. Am J Perinatol 2017;34:927–934.Google ScholarPubMed
Sanger, PC, Hartzler, A, Han, SM, et al. Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution. PLoS One 2014;9(12):e114016.CrossRefGoogle ScholarPubMed
Jing, L, Bethancourt, CN, McDonagh, T. Assessing infant and maternal readiness for newborn discharge. Curr Opin Pediatr 2017;29:598–605.CrossRefGoogle ScholarPubMed
Spencer, CS, Roberts, ET, Gaskin, DJ. Differences in the rates of patient safety events by payer: implications for providers and policymakers. Med Care 2015;53:524–529.CrossRefGoogle ScholarPubMed
Kozhimannil, KB, Shippee, TP, Adegoke, O, Vemig, BA. Trends in hospital-based childbirth care: the role of health insurance. Am J Manag Care 2013;19(4):e125–e132.Google ScholarPubMed
Spencer, CS, Gaskin, DJ, Roberts, ET. The quality of care delivered to patients within the same hospital varies by insurance type. Health Affairs 2013;32:1731–1739.CrossRefGoogle ScholarPubMed
Ju, MH, Ko, CY, Hall, BL, Bosk, CL, Bilimoria, KY, Wick, EC. A comparison of 2 surgical site infection monitoring systems. JAMA Surg 2015;150:51–57.CrossRefGoogle ScholarPubMed
Moro, ML, Morsillo, F, Tangenti, M, et al. Rates of surgical-site infection: an international comparison. Infect Control Hosp Epidemiol 2005;26:442–448.CrossRefGoogle Scholar
Garcia, TC, Bernstein, AB, Bush, MA. Emergency department visitors and visits: who used the emergency room in 2007? NCHS Data Brief 2010;38:1–8.Google Scholar
National Center for Health Statistics. Health, United States, 2016: with chartbook on long-term trends in health. Centers for Disease Control and Prevention website. https://www.cdc.gov/nchs/data/hus/hus16.pdf. Accessed December 13, 2017.Google Scholar
California health and safety code. Californa Legislation information website. https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=HSC&division=2.&title=&part=&chapter=2.&article=3.5. Accessed February 27, 2018.Google Scholar
Anderson, V, Chaboyer, W, Gillespie, B. The relationship between obesity and surgical site infections in women undergoing caesarean sections: an integrative review. Midwifery 2013;29:1331–1338.CrossRefGoogle Scholar
New York State Public Health Law, section 2819. New York Health Department website. https://www.health.ny.gov/regulations/public_health_law/section/2819/. Accessed February 27, 2018.Google Scholar
Supplementary material: File

Yi et al. supplementary material

Yi et al. supplementary material 1

Download Yi et al. supplementary material(File)
File 598 KB