Background: To determine incidence of SSI, endometritis (EMM), septicemia, UTI, and pelvic abscess during delivery admission, ED visit, and 6-week readmission stratified by delivery method in California, New York, and Florida.
Methods: We used 2005-2011 HCUP CA, 2006-2012 NY, and 2005-2013 FL State Inpatient and ED Databases to determine the incidence of postpartum infections in women following vaginal and cesarean delivery. Infections were identified by ICD-9-CM diagnosis codes. Univariate analyses were performed, stratified by type of delivery.
Results: A total of 5,502,603 deliveries (34.5% cesarean) were identified. Overall 186,555 (3.39%) of deliveries were coded for one or more of the following post-partum infections; SSI, EMM, septicemia, UTI, or pelvic abscess.
In the cesarean delivery population, the postpartum infections identified in order of frequency were UTI (n=45,133), SSI (n=43,549), EMM (n=23,240), septicemia (n=3503), and pelvic abscess (n=2251). SSIs were most commonly first identified during an ED visit (44.7%), while EMM, septicemia, and UTI were most often first identified during the delivery hospitalization (76.1, 70.0, and 56%, respectively).
In the vaginal delivery population, the postpartum infections identified in order of frequency were UTI (n=62,486), EMM (n=12,306), septicemia (n=3033), and pelvic abscess (n=2209). Pelvic abscess and septicemia were most commonly first identified during the delivery hospitalization (73.0 and 68.9% respectively), UTIs were first identified at delivery (50.0%) and at ED visit (41.4%), and EMM was most often identified at delivery (48.0%) and at readmission (42.0%).
Conclusion: The proportion of patients diagnosed at delivery versus readmission or ED visit varied by type of postpartum infection. A higher proportion of septicemia and pelvic abscess cases were coded at delivery after cesarean and vaginal delivery. After vaginal delivery, a higher proportion of EMM cases were coded during a readmission and after cesarean most were coded at delivery. A higher proportion of UTI and SSI cases were diagnosed at ED visit compared to other infections. Surveillance should focus on identification of these infections before discharge from the delivery hospitalization.
K. M. Bommarito,
M. Olsen, Sanofi Pasteur: Consultant and Grant Investigator , Research grant