Impact of cesarean versus vaginal delivery on the risk of postpartum acute kidney injury: A retrospective database controlled study in 116,876 parturients
The rate of cesarean delivery is increasing globally but the risk of perioperative organ injury associated with cesarean delivery is not well defined. The objective of this study was to determine the risk of postpartum acute kidney injury, a peripartum complication defined by an acute decrease in ki...
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Published in | Journal of clinical anesthesia Vol. 82; p. 110915 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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Elsevier Inc
01.11.2022
Elsevier Limited |
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Abstract | The rate of cesarean delivery is increasing globally but the risk of perioperative organ injury associated with cesarean delivery is not well defined. The objective of this study was to determine the risk of postpartum acute kidney injury, a peripartum complication defined by an acute decrease in kidney function, associated with cesarean delivery compared to vaginal delivery.
Population-based discharge database.
The Optum Clinformatics® Data Mart was queried for parturients that underwent cesarean or vaginal delivery between January 2016 to January 2018. Using a propensity score model based on 27 antepartum characteristics, we generated a final matched cohort of 116,876 parturients.
Cesarean delivery as the mode of delivery.
The risk of acute kidney injury associated with each delivery mode and the effect of acute kidney injury on the length of hospital stay for parturients.
The matched cohort consisted of 116,876 deliveries, with 58,438 cases in each group. In the cesarean delivery group, the incidence of postpartum acute kidney injury was 24.5 vs. 7.9 per 10,000 deliveries in the vaginal delivery group (adjusted odds ratio = 3; 95% CI, 2.13–4.22; P < .001). The median of the length of hospital stay [interquartile range] was longer by 50% in parturients who developed postpartum acute kidney injury after vaginal delivery (3 [2–4] days vs. those who did not, 2 [2, 3] days; P < .001) and by 67% after cesarean delivery (5 [4–7] days vs. 3 [3, 4] days; P < .001).
Cesarean delivery is associated with a significantly increased risk of postpartum acute kidney injury as compared to vaginal delivery. The development of postpartum acute kidney injury is associated with prolonged length of hospital stay.
•Analysis of 116,876 parturients from a nationally representative database.•Cesarean delivery is associated with a higher risk of postpartum acute kidney injury.•Postpartum acute kidney injury is associated with a longer length of hospital stay. |
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AbstractList | Study objectiveThe rate of cesarean delivery is increasing globally but the risk of perioperative organ injury associated with cesarean delivery is not well defined. The objective of this study was to determine the risk of postpartum acute kidney injury, a peripartum complication defined by an acute decrease in kidney function, associated with cesarean delivery compared to vaginal delivery.SettingPopulation-based discharge database.PatientsThe Optum Clinformatics® Data Mart was queried for parturients that underwent cesarean or vaginal delivery between January 2016 to January 2018. Using a propensity score model based on 27 antepartum characteristics, we generated a final matched cohort of 116,876 parturients.Intervention/ExposureCesarean delivery as the mode of delivery.MeasurementsThe risk of acute kidney injury associated with each delivery mode and the effect of acute kidney injury on the length of hospital stay for parturients.Main resultsThe matched cohort consisted of 116,876 deliveries, with 58,438 cases in each group. In the cesarean delivery group, the incidence of postpartum acute kidney injury was 24.5 vs. 7.9 per 10,000 deliveries in the vaginal delivery group (adjusted odds ratio = 3; 95% CI, 2.13–4.22; P < .001). The median of the length of hospital stay [interquartile range] was longer by 50% in parturients who developed postpartum acute kidney injury after vaginal delivery (3 [2–4] days vs. those who did not, 2 [2, 3] days; P < .001) and by 67% after cesarean delivery (5 [4–7] days vs. 3 [3, 4] days; P < .001).ConclusionsCesarean delivery is associated with a significantly increased risk of postpartum acute kidney injury as compared to vaginal delivery. The development of postpartum acute kidney injury is associated with prolonged length of hospital stay. The rate of cesarean delivery is increasing globally but the risk of perioperative organ injury associated with cesarean delivery is not well defined. The objective of this study was to determine the risk of postpartum acute kidney injury, a peripartum complication defined by an acute decrease in kidney function, associated with cesarean delivery compared to vaginal delivery. Population-based discharge database. The Optum Clinformatics® Data Mart was queried for parturients that underwent cesarean or vaginal delivery between January 2016 to January 2018. Using a propensity score model based on 27 antepartum characteristics, we generated a final matched cohort of 116,876 parturients. Cesarean delivery as the mode of delivery. The risk of acute kidney injury associated with each delivery mode and the effect of acute kidney injury on the length of hospital stay for parturients. The matched cohort consisted of 116,876 deliveries, with 58,438 cases in each group. In the cesarean delivery group, the incidence of postpartum acute kidney injury was 24.5 vs. 7.9 per 10,000 deliveries in the vaginal delivery group (adjusted odds ratio = 3; 95% CI, 2.13–4.22; P < .001). The median of the length of hospital stay [interquartile range] was longer by 50% in parturients who developed postpartum acute kidney injury after vaginal delivery (3 [2–4] days vs. those who did not, 2 [2, 3] days; P < .001) and by 67% after cesarean delivery (5 [4–7] days vs. 3 [3, 4] days; P < .001). Cesarean delivery is associated with a significantly increased risk of postpartum acute kidney injury as compared to vaginal delivery. The development of postpartum acute kidney injury is associated with prolonged length of hospital stay. •Analysis of 116,876 parturients from a nationally representative database.•Cesarean delivery is associated with a higher risk of postpartum acute kidney injury.•Postpartum acute kidney injury is associated with a longer length of hospital stay. |
ArticleNumber | 110915 |
Author | Eltzschig, Holger K. Potnuru, Paul P. Jiang, Yandong Ganduglia, Cecilia Suresh, Maya Schaefer, Caroline M. |
Author_xml | – sequence: 1 givenname: Paul P. surname: Potnuru fullname: Potnuru, Paul P. organization: Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA – sequence: 2 givenname: Cecilia surname: Ganduglia fullname: Ganduglia, Cecilia organization: School of Public Health, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA – sequence: 3 givenname: Caroline M. surname: Schaefer fullname: Schaefer, Caroline M. organization: School of Public Health, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA – sequence: 4 givenname: Maya surname: Suresh fullname: Suresh, Maya organization: Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA – sequence: 5 givenname: Holger K. surname: Eltzschig fullname: Eltzschig, Holger K. organization: Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA – sequence: 6 givenname: Yandong surname: Jiang fullname: Jiang, Yandong email: Yandong.jiang@uth.tmc.edu organization: Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA |
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Keywords | Pregnancy Cesarean delivery Vaginal delivery Perioperative organ injury Acute kidney injury Mode of delivery Postpartum complications |
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Snippet | The rate of cesarean delivery is increasing globally but the risk of perioperative organ injury associated with cesarean delivery is not well defined. The... Study objectiveThe rate of cesarean delivery is increasing globally but the risk of perioperative organ injury associated with cesarean delivery is not well... STUDY OBJECTIVEThe rate of cesarean delivery is increasing globally but the risk of perioperative organ injury associated with cesarean delivery is not well... |
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SubjectTerms | Acute kidney injury Bias Cesarean delivery Cesarean section Childbirth & labor Comorbidity Diabetes Kidneys Mode of delivery Mortality Obstetrics Perioperative organ injury Postpartum complications Pregnancy Surgery Vagina Vaginal delivery |
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Title | Impact of cesarean versus vaginal delivery on the risk of postpartum acute kidney injury: A retrospective database controlled study in 116,876 parturients |
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