OBJECTIVES : To quantify the healthcare utilization burden of antibiotic-treated surgical site infection (SSI) within 30 days of cesarean section (CS) among patients under care in an integrated delivery network within the midwestern United States.

METHODS : Retrospective observational cohort study of electronic health records (EHRs). Patients included for study were females aged 18-50 years, undergoing CS between 1/1/2016 and 9/30/2019 (date of surgery = index) in an integrated delivery network comprising 40 acute care and specialty hospitals and 800 physician practices and outpatient facilities. Only those with clinical records in the EHR from ≥30 days before and ≥30 days after CS were included. Occurrence of SSI within 30 days of CS was defined as the presence of both: (a) documented diagnosis of infection of obstetric surgical wound or infection following a procedure; and (b) non-prophylactic antibiotic treatment within ±1 day of SSI diagnosis. The outcomes of interest were all-cause inpatient readmissions, emergency room (ER) visits, and outpatient/ambulatory visits, as well as all-cause and antibiotic medication orders over the 30-day follow-up. Multivariable regression was used to examine the association of SSI with the outcomes of interest; recycled prediction was used to calculate adjusted outcomes.

RESULTS : A total of 17,877 patients were identified; 37 (0.21%) experienced SSI at index and 365 (2.04%) experienced SSI at follow-up. In the adjusted model, those with SSI were more likely to experience all-cause inpatient readmission (22.11% vs 1.93%, P<0.001), ER visits (29.19% vs 7.43%, P<0.001), outpatient/ambulatory visits (3.58 vs 1.24) compared to those without. Those with SSI also had more all-cause medication orders (12.21 vs 1.75, P<0.001) and more antibiotic medication orders at follow-up (3.05% vs 0.21%, P<0.001) compared to those without.

CONCLUSIONS : Antibiotic-treated SSI following CS was significantly associated with increased healthcare utilization burden including higher utilization rates in inpatient, emergency, and outpatient/ambulatory settings, as well as increased medication use.