{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T16:35:32Z","timestamp":1785602132450,"version":"3.56.0"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This study aimed to determine the incidence of reoperation after uncomplicated cesarean birth, describe the types of procedures and indications for reoperation, and identify risk factors associated with reoperation using a national surgical database.<\/jats:p><jats:p>A retrospective cross-sectional study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database, encompassing data from January 1, 2019, to December 31, 2021. A total of 43,492 patients who underwent cesarean birth were included. Patients who underwent concurrent nongynecologic procedures or hysterectomies were excluded. The primary outcomes measured were the incidence of unplanned reoperation within 30 days of cesarean birth, types of reoperative procedures, indications for reoperation, and associated risk factors. Statistical analyses included Student's t-test, Wilcoxon rank-sum test, chi-squared test, and multivariable logistic regression.<\/jats:p><jats:p>Out of 43,492 cesarean deliveries, 397 (0.9%) required unplanned reoperation. Significant risk factors for reoperation included smoking (adjusted odds ratio [aOR]: 1.96, 95% confidence interval [CI]: 1.49\u20131.56), hypertension (aOR: 1.83, 95% CI: 1.27\u20132.62), bleeding disorders (aOR: 2.11, 95% CI: 1.15\u20133.89), American Society of Anesthesiologists (ASA) class\u2009&gt;\u20093 (aOR: 2.23, 95% CI: 1.29\u20133.84), and concurrent myomectomy (aOR: 4.39, 95% CI: 1.06\u201318.2). The most common indications for reoperation were postpartum hemorrhage (47%), wound disruption or infection (18%), and hematoma or hemoperitoneum (14%). The most frequently performed reoperative procedures were exploratory laparotomy without hysterectomy (27%), uterine curettage (23%), and wound debridement or drainage (22%).<\/jats:p><jats:p>Reoperation following cesarean birth is a relatively uncommon but significant event, occurring in 0.9% of cases. Key risk factors include smoking, hypertension, bleeding disorders, ASA class\u2009&gt;\u20093, and concurrent myomectomy. This study provides comprehensive data on the clinical characteristics and indications for reoperation following cesarean birth in a diverse, multi-institutional US cohort. The findings highlight the need for enhanced perioperative monitoring and targeted interventions for high-risk patients to improve maternal outcomes.<\/jats:p>","DOI":"10.1055\/a-2542-9318","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T18:51:41Z","timestamp":1740077501000},"page":"1657-1663","source":"Crossref","is-referenced-by-count":2,"title":["Reoperation following Cesarean Birth: An Analysis of Incidence, Indications, and Procedures Using a National Surgical Database"],"prefix":"10.1055","volume":"42","author":[{"given":"Luke P.","family":"Burns","sequence":"additional","affiliation":[{"name":"The University of Chicago Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jourdan E.","family":"Triebwasser","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher X.","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"384.e1","DOI":"10.1016\/j.ajog.2015.05.002","article-title":"Morbidity associated with cesarean delivery in the United States: is placenta accreta an increasingly important contributor?","volume":"213","author":"A A Creanga","year":"2015","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"101362","DOI":"10.1016\/j.ajogmf.2024.101362","article-title":"Evidence-based cesarean delivery: preoperative management (part 7)","volume":"6","author":"A D Mackeen","year":"2024","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1097\/AOG.0000000000004972","article-title":"Postpartum hemorrhage trends and outcomes in the United States, 2000-2019","volume":"141","author":"C M Corbetta-Rastelli","year":"2023","journal-title":"Obstet Gynecol"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"463","DOI":"10.3109\/14767058.2013.818970","article-title":"Peripartum complications with cesarean delivery: a review of maternal-fetal medicine units network publications","volume":"27","author":"I A Hammad","year":"2014","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1097\/AOG.0000000000002249","article-title":"Evidence-based bundles and cesarean delivery surgical site infections: a systematic review and meta-analysis","volume":"130","author":"E B Carter","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"449.e1","DOI":"10.1016\/j.ajog.2017.05.070","article-title":"Impact of evidence-based interventions on wound complications after cesarean delivery","volume":"217","author":"L A Temming","year":"2017","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"35.e1","DOI":"10.1016\/j.ajog.2009.08.029","article-title":"Hospital readmission after delivery: evidence for an increased incidence of nonurogenital infection in the immediate postpartum period","volume":"202","author":"M A Belfort","year":"2010","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1097\/AOG.0000000000002269","article-title":"Emergency department care in the postpartum period: California births, 2009-2011","volume":"130","author":"P Batra","year":"2017","journal-title":"Obstet 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Obstet"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.ejogrb.2018.04.034","article-title":"Relaparotomy following cesarean section - a single center study","volume":"225","author":"H Huras","year":"2018","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"11","key":"ref14","doi-asserted-by":"crossref","first-page":"2167","DOI":"10.3109\/14767058.2012.668978","article-title":"Risk factors for relaparotomy after cesarean section","volume":"25","author":"R Kessous","year":"2012","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.ijgo.2012.05.037","article-title":"Risk factors for relaparotomy after cesarean delivery","volume":"119","author":"I Levin","year":"2012","journal-title":"Int J Gynaecol Obstet"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"607","DOI":"10.3109\/14767058.2015.1012065","article-title":"Re-laparotomy 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