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Trends, outcomes and patient- and hospital-level factors associated with sepsis following cesarean delivery: a propensity-matched nationwide inpatient analysis (2016–2022)

Year: 2026

Type: article

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.

Source: Frontiers in Surgery

DOI: 10.3389/fsurg.2026.1871936