New UCSF measure shows 1 in 60 cesarean deliveries involve serious surgical complications

Editor's Note

Roughly one in every 60 cesarean deliveries results in a severe surgical complication, according to new research from University of California San Francisco (UCSF) published in Obstetrics and Gynecology, MedicalXpress August 25 reports. With about 1.1 million cesareans performed each year in the US, this translates to an estimated 18,000 patients annually experiencing significant intraoperative harm.

Cesarean delivery is reportedly the nation’s most common inpatient surgery, yet prior studies have blurred the picture of surgical risk by combining anesthesia- and medicine-related complications with surgical ones. To address this, UCSF researchers developed a novel population-based measure of severe perioperative surgical morbidity (SPSM), drawing exclusively on surgery-specific outcomes. The tool relies on routinely collected hospital claims data, making it a potential foundation for monitoring surgical quality and guiding hospital improvement efforts, said first author Alexander Butwick, MBBS, FRCA, MS.

The retrospective study examined nearly 600,000 California births between 2016 and 2021. Researchers found 10,182 cases of SPSM, with wound complications the most frequent, followed by bladder or pelvic injuries, ileus or bowel obstruction, and intraoperative bowel injury. Complication rates were higher among intrapartum cesareans—those performed after labor had begun—compared with pre-labor procedures. The authors suggest this reflects the increased technical challenges and higher risk of uterine atony associated with attempted labor prior to surgery.

According to the article, patients with placenta accreta spectrum disorder faced the greatest SPSM risk due to the condition’s association with major hemorrhage, distorted anatomy, and complex surgical management. Elevated risks were also observed in patients with placenta previa and chorioamnionitis, both linked to higher hemorrhage risk and surgical difficulty.

By isolating surgical complications, UCSF’s approach provides a clearer and more precise picture of cesarean risk, notes the outlet. The findings highlight not only the burden of complications but also the need for systematic monitoring and quality improvement to reduce preventable morbidity in obstetric care.