Methods
The Nationwide Inpatient Sample (NIS) was used to identify delivery and postpartum discharges from 2008-2010. Women with and without sepsis based on International Classification of Diseases, 9th Revision (ICD-9) codes were identified for comparison. For the purposes of this study, sepsis was defined as an ICD-9 code of septicemia or bacteremia, as sepsis was not a defined ICD-9 code within the specified time frame. Medical events and acute infections were determined among women with a diagnosis of sepsis and compared to women without a diagnosis of sepsis. Logistic regression analyses were used to compute odds ratios (OR) and 95% confidence intervals (95% CI) for demographic data, pre-existing medical conditions, and acute medical and infectious complications for women with sepsis versus without sepsis.
Methods
The Nationwide Inpatient Sample (NIS) was used to identify delivery and postpartum discharges from 2008-2010. Women with and without sepsis based on International Classification of Diseases, 9th Revision (ICD-9) codes were identified for comparison. For the purposes of this study, sepsis was defined as an ICD-9 code of septicemia or bacteremia, as sepsis was not a defined ICD-9 code within the specified time frame. Medical events and acute infections were determined among women with a diagnosis of sepsis and compared to women without a diagnosis of sepsis. Logistic regression analyses were used to compute odds ratios (OR) and 95% confidence intervals (95% CI) for demographic data, pre-existing medical conditions, and acute medical and infectious complications for women with sepsis versus without sepsis.
Results
Out of 12.6 million delivery and postpartum hospital discharges from 2008-2010, 6304 women were diagnosed with sepsis at delivery and 3539 women were diagnosed with sepsis at postpartum discharge. Women with sepsis at delivery were more likely to have non-private insurance (60.2% vs 50.3%%, p <0.0001) and to reside in a ZIP code with median income in the bottom quartile (31.9% vs 26.4%, p <0.0001). Women with sepsis at delivery were also more likely to have underlying medical conditions of drug use, hypertension, diabetes, or HIV (p <0.0001). Women with sepsis at delivery or postpartum discharge were at a significantly increased risk of multiple medical comorbidities including death, mechanical ventilation, blood transfusion, pneumonia, respiratory distress syndrome, and acute renal failure. After controlling for confounding variables and interaction terms, sepsis continued to be associated with multiple medical comorbidities (Table). The association with comorbidities was significantly increased in patients without endometritis in the delivery discharge group but not in the postpartum discharge group.
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