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

• Published in: Infection control and hospital epidemiology Vol. 40; no. 6; pp. 639 - 648
• Main Authors: Yi, Sarah H, Perkins, Kiran M, Kazakova, Sophia V, Hatfield, Kelly M, Kleinbaum, David G, Baggs, James, Slayton, Rachel B, Jernigan, John A
• Format: Journal Article
• Language: English
• Published: United States Cambridge University Press 01.06.2019
• Subjects: Adolescent; Adult; Body mass index; California - epidemiology; Cesarean section; Cesarean Section - adverse effects; Cesarean Section - economics; Cesarean Section - statistics & numerical data; Child; Female; Government programs; Health care; Health insurance; Health risks; Hospitals; Humans; Insurance coverage; Insurance, Health - statistics & numerical data; Logistic Models; Medicaid - statistics & numerical data; Multivariate Analysis; Nursing; Patient safety; Pregnancy; Private Sector; Retrospective Studies; Risk Factors; Surgical site infections; Surgical Wound Infection - epidemiology; United States; Womens health; Young Adult; United States; California; United States > US
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2019.66

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