{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T04:05:22Z","timestamp":1745294722038,"version":"3.40.4"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This study aimed to identify risk factors for postpartum readmission (PPR) in class 3 obese patients undergoing unscheduled cesarean deliveries.<\/jats:p><jats:p>Retrospective cohort study of patients with a body mass index (BMI) of \u226540\u2009kg\/m2 undergoing unscheduled cesarean delivery from 2017 to 2020 comparing patients with and without PPR (unexpected admission, emergency room\/overnight observation visit, unscheduled outpatient visit, or ambulatory surgery within 30 days). Medical history, operative data, and postpartum outcomes were compared between the cohorts.<\/jats:p><jats:p>The electronic medical record was queried to identify cesarean deliveries documented as \u201cunscheduled.\u201d In total, 255 of 1,273 identified patients (20.0%) had a PPR. Median BMI was similar between the cohorts (44.2\u2009kg\/m2, interquartile range [IQR]: [41.8, 47.9] vs. 44.8\u2009kg\/m2 [42.0, 48.9], p\u2009=\u20090.066). Readmitted patients were more likely to have a history of smoking during or prior to pregnancy (p\u2009=\u20090.046). A subgroup exploratory analysis excluding outpatient and emergency room visits demonstrated higher rates of type II diabetes mellitus in patients with PPR (11.5 vs. 4.6%, p\u2009=\u20090.030). Patients with readmission in comparison to those without readmissions were less likely to receive cefazolin prophylaxis (78.0 vs. 84.3%, p\u2009=\u20090.014) in comparison to gentamicin\/clindamycin prophylaxis. Patients with readmission were less likely to have had vaginal preparation (56.9 vs. 64.3%, p\u2009=\u20090.027). On multivariable logistic regression analysis, smoking history (odds ratio [OR]\u2009=\u20091.44, 95% confidence interval [CI]: 1.06\u20131.96, p\u2009=\u20090.0220) and hypertensive disease (OR\u2009=\u20091.57, 95% CI: 1.18\u20132.09, p\u2009=\u20090.002) were associated with readmission. Cefazolin preoperative prophylaxis (OR\u2009=\u20090.59, 95% CI: 0.41\u20130.84, p\u2009=\u20090.004) and vaginal sterile preparation (OR\u2009=\u20090.72, 95% CI: 0.54\u20130.95, p\u2009=\u20090.022) were associated with decreased risk of readmission.<\/jats:p><jats:p>In class 3 obese patients, a history of smoking and a diagnosis of hypertensive disease are associated with an increased risk of PPR. Perioperative antibiotic prophylaxis with cefazolin along with vaginal sterile preparation associate with a decreased risk of PPR.<\/jats:p>","DOI":"10.1055\/a-2445-3123","type":"journal-article","created":{"date-parts":[[2024,10,19]],"date-time":"2024-10-19T01:17:12Z","timestamp":1729300632000},"page":"933-940","source":"Crossref","is-referenced-by-count":0,"title":["Postpartum Readmission after Unscheduled Cesarean Delivery in Patients with Class 3 Obesity"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7438-5837","authenticated-orcid":false,"given":"Surabhi","family":"Tewari","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio"},{"name":"Department of Obstetrics and Gynecology, Brigham and Women's Hospital\/Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meng","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lydia","family":"DeAngelo","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Rogness","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren","family":"Buckley","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swapna","family":"Kollikonda","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oluwatosin","family":"Goje","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1179-3654","authenticated-orcid":false,"given":"Maeve","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio"},{"name":"Department of Maternal-Fetal Medicine, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, 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