Trends, outcomes and patient- and hospital-level factors associated with sepsis following cesarean delivery: a propensity-matched nationwide inpatient analysis (2016–2022)
4 affiliations
- 1Department of Anesthesiology, Dongguan Tungwah Hospital, Dongguan, China
- 2Dongguan Key Laboratory of Anesthesia and Enhanced Recovery After Surgery, Dongguan Tungwah Hospital, Dongguan, Guangdong, China
- 3Department of Anesthesiology, Dongguan SongShan Lake Tungwah Hospital, Dongguan, China
- 4Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
Abstract
Background: Sepsis is a major global health concern and a serious complication of cesarean delivery. However, contemporary nationwide data describing both the temporal trend in post-cesarean sepsis and its downstream clinical and economic burden—particularly in propensity-matched comparisons—remain limited.
Methods: We conducted a retrospective, propensity-matched analysis of all adult inpatients undergoing cesarean delivery recorded in the U.S. Nationwide Inpatient Sample (NIS, 2016–2022). Sepsis and cesarean delivery were defined using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. After 1:5 propensity-score matching on demographics, comorbidity burden and hospital characteristics, we compared in-hospital mortality, length of stay (LOS), total hospitalization costs, and the incidence of perioperative complications between septic and non-septic patients. Multivariable logistic regression was used to identify patient- and hospital-level factors independently associated with sepsis.
Results: Of 1,619,187 hospitalizations for cesarean delivery, 1,589,186 adults met the inclusion criteria. Annual sepsis prevalence rose from 0.058% in 2016 to 0.136% in 2022. In the 1:5 propensity-matched cohort (n = 10,050), septic patients had markedly higher in-hospital mortality (2.4% vs. 0.0%, P < 0.001), longer median LOS (6 vs. 3 days, P < 0.001), and approximately 2.6-fold higher median total hospitalization costs (USD 71,466 vs. USD 27,063, P < 0.001). Non-elective admission, treatment in teaching hospitals, a higher comorbidity burden, Asian/Pacific Islander race, and hospital region were independently associated with sepsis. After propensity matching, septic patients also showed substantially elevated adjusted odds of pulmonary embolism (OR 61.7), postoperative shock (OR 28.7), deep-vein thrombosis (OR 24.6), urinary tract infection (OR 25.5), and chronic respiratory diseases (OR 13.2).
Conclusions: In this large U.S. study, sepsis after cesarean section was linked to much higher death rates, twice the hospital stay, about 2.6 times higher costs, and more severe problems like blood clots, shock, infections, and heavy bleeding. These results show that post-cesarean section sepsis is a growing concern, remind us to spot at-risk mothers early, and offer a benchmark against which prevention and cost-effective care can be evaluated.
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BibTeX
@article{lan2026trends,
title = {{Trends, outcomes and patient- and hospital-level factors associated with sepsis following cesarean delivery: a propensity-matched nationwide inpatient analysis (2016–2022)}},
author = {Lanhui Lan and Xueliang Liu and Xianghua Cao and Lili Zheng and Fengshan Gong and Jian Wang and Qinfeng Yang and Xueping Li and Haoran Yan},
journal = {Frontiers in Surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1871936},
url = {https://doi.org/10.3389/fsurg.2026.1871936},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Trends, outcomes and patient- and hospital-level factors associated with sepsis following cesarean delivery: a propensity-matched nationwide inpatient analysis (2016–2022)
AU - Lanhui Lan
AU - Xueliang Liu
AU - Xianghua Cao
AU - Lili Zheng
AU - Fengshan Gong
AU - Jian Wang
AU - Qinfeng Yang
AU - Xueping Li
AU - Haoran Yan
PY - 2026
DA - 2026/10/21
JO - Frontiers in Surgery
DO - 10.3389/fsurg.2026.1871936
UR - https://doi.org/10.3389/fsurg.2026.1871936
AB - Background: Sepsis is a major global health concern and a serious complication of cesarean delivery. However, contemporary nationwide data describing both the temporal trend in post-cesarean sepsis and its downstream clinical and economic burden—particularly in propensity-matched comparisons—remain limited. Methods: We conducted a retrospective, propensity-matched analysis of all adult inpatients undergoing cesarean delivery recorded in the U.S. Nationwide Inpatient Sample (NIS, 2016–2022). Sepsis and cesarean delivery were defined using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. After 1:5 propensity-score matching on demographics, comorbidity burden and hospital characteristics, we compared in-hospital mortality, length of stay (LOS), total hospitalization costs, and the incidence of perioperative complications between septic and non-septic patients. Multivariable logistic regression was used to identify patient- and hospital-level factors independently associated with sepsis. Results: Of 1,619,187 hospitalizations for cesarean delivery, 1,589,186 adults met the inclusion criteria. Annual sepsis prevalence rose from 0.058% in 2016 to 0.136% in 2022. In the 1:5 propensity-matched cohort (n = 10,050), septic patients had markedly higher in-hospital mortality (2.4% vs. 0.0%, P < 0.001), longer median LOS (6 vs. 3 days, P < 0.001), and approximately 2.6-fold higher median total hospitalization costs (USD 71,466 vs. USD 27,063, P < 0.001). Non-elective admission, treatment in teaching hospitals, a higher comorbidity burden, Asian/Pacific Islander race, and hospital region were independently associated with sepsis. After propensity matching, septic patients also showed substantially elevated adjusted odds of pulmonary embolism (OR 61.7), postoperative shock (OR 28.7), deep-vein thrombosis (OR 24.6), urinary tract infection (OR 25.5), and chronic respiratory diseases (OR 13.2). Conclusions: In this large U.S. study, sepsis after cesarean section was linked to much higher death rates, twice the hospital stay, about 2.6 times higher costs, and more severe problems like blood clots, shock, infections, and heavy bleeding. These results show that post-cesarean section sepsis is a growing concern, remind us to spot at-risk mothers early, and offer a benchmark against which prevention and cost-effective care can be evaluated.
SN - 2296-875X
ER -