Mothers in Medicaid may have higher C-section infection risk than those with private insurance

The risk of surgical site infection following cesarean delivery is higher among Medicaid-insured women when compared to women who were privately insured, according to a study published in Infection Control and Hospital Epidemiology and backed by the Centers for Disease Control and Prevention.

Mothers delivering via cesarean section covered by Medicaid had a 1.4 fold increase in infection compared to those covered by private insurance, findings showed.

IMPACT

One-third of births in the U.S. occur by cesarean delivery, or C-section; in 2014, about 40 percent of cesarean births were covered by Medicaid. While lifesaving in some cases, cesarean deliveries have additional risks, including surgical site infection.

Researchers used linked data from CDC's National Healthcare Safety Network and state inpatient discharge data to identify surgical site infections in the 30 days following C-section from a pool of 291,757 C-section deliveries that occurred from 2011-2013 in California; 48 percent of this total were covered by Medicaid.

Surgical site infections were detected in 0.75 percent of deliveries covered by Medicaid and 0.63 percent of those covered by private insurance. Surgical site infections were more frequently detected during post-discharge surveillance and hospital readmission than during the original hospitalization. Risk of surgical site infection during the original hospitalization was small, and didn't differ by payer type.

The increased risk, authors said, may stem from a combination of factors, including patient, provider, facility and state policy considerations. Examples include patient health literacy, patient living situation, available social support following hospital discharge, and payer-driven differences in healthcare provision.

Plus, ensuring readiness for discharge and adequate discharge education may be important interventions to improve outcomes among patients with social, economic and other vulnerabilities.

THE TREND

Despite evidence that expert recommendations such as tracking blood loss, not relying on visual estimates and the timely administering of medication for high blood pressure can prevent death among birthing mothers, a USA Today investigation in July 2018 found that many hospitals skip the practices altogether, endangering patients' lives.

The investigation said failing to track blood loss during childbirth and not administering blood pressure medication within an hour of dangerously high blood pressure readings can lead to strokes, massive hemorrhaging to the point of organ failure, blood clots, infections and the inability to bear more children.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com