Postpartum Readmission after Unscheduled Cesarean Delivery in Patients with Class 3 Obesity

Objective This study aimed to identify risk factors for postpartum readmission (PPR) in class 3 obese patients undergoing unscheduled cesarean deliveries. Study Design Retrospective cohort study of patients with a body mass index (BMI) of >= 40 kg/m 2 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. Results The electronic medical record was queried to identify cesarean deliveries documented as "unscheduled." In total, 255 of 1,273 identified patients (20.0%) had a PPR. Median BMI was similar between the cohorts (44.2 kg/m 2 , interquartile range [IQR]: [41.8, 47.9] vs. 44.8 kg/m 2 [42.0, 48.9], p = 0.066). Readmitted patients were more likely to have a history of smoking during or prior to pregnancy ( p = 0.046). 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 = 0.030). Patients with readmission in comparison to those without readmissions were less likely to receive cefazolin prophylaxis (78.0 vs. 84.3%, p = 0.014) in comparison to gentamicin/clindamycin prophylaxis. Patients with readmission were less likely to have had vaginal preparation (56.9 vs. 64.3%, p = 0.027). On multivariable logistic regression analysis, smoking history (odds ratio [OR] = 1.44, 95% confidence interval [CI]: 1.06-1.96, p = 0.0220) and hypertensive disease (OR = 1.57, 95% CI: 1.18-2.09, p = 0.002) were associated with readmission. Cefazolin preoperative prophylaxis (OR = 0.59, 95% CI: 0.41-0.84, p = 0.004) and vaginal sterile preparation (OR = 0.72, 95% CI: 0.54-0.95, p = 0.022) were associated with decreased risk of readmission. Conclusion 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.