Mothers covered by Medicaid face a higher risk of C-section infection

Medicaid-insured women who have cesarean deliveries suffer a higher incidence of surgical site infections (SSIs) compared to women who have private insurance and researchers say they aren’t sure why. The study was published in the Tuesday in Infection Control & Hospital Epidemiology, the journal for the Society for Healthcare Epidemiology of America (SHEA). Data from the Centers for Disease Control and Prevention (CDC) shows mothers delivering via cesarean section covered by Medicaid had a 1.4-fold increase in infection compared to those covered by private insurance.

“The findings force researchers to look beyond the usual suspects behind surgical site infections,” says CDC health scientist Sarah Yi, PhD, lead author of the study. “More investigation is needed to determine why women with Medicaid health insurance had a much greater burden of surgical site infections after cesarean delivery than privately insured women.”

SHEA says this is the largest study to date to examine the role of health insurance coverage in the risk of SSI following cesarean deliveries in the U.S.

One-third of U.S. babies were born via C-section with 40 percent of them covered by Medicaid in 2014. Sometimes the procedure is required to save the lives of mother and baby, but they also come with some risks, such as SSIs. In discovering the discrepancy between privately-insured uninsured and Medicaid-covered women the researchers reviewed linked data from CDC’s National Healthcare Safety Network (NHSN) 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 those procedures were covered by Medicaid).

Surgical site infections were detected in 1,055 deliveries (0.75%) covered by Medicaid and 955 deliveries (0.63%) 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 did not differ by payer type.

More research is needed to identify why this happens, but the authors suggest the increased risk to women with Medicaid may stem from a combination of factors:

· patient health literacy

· patient living situation

· available social support following hospital discharge

· payer-driven differences in healthcare provision

· readiness for discharge

·  inadequate discharge education

This study may have been limited by the lack of information on post-discharge surveillance methods. Due to data limitations researchers were unable to account for other potential confounders, including marital status, repeated pregnancy loss, duration of insurance coverage, and prenatal and postnatal care.

Nonetheless, providing good education on how to take care of C-section wounds may be important interventions to improve outcomes among patients with social, economic, and other vulnerabilities. “These findings suggest the need to evaluate maternal healthcare delivered to women covered by Medicaid to inform targeted infection prevention efforts by hospitals serving vulnerable patient groups.”

In fact, a new data report from the Agency for Healthcare Research and Quality says communication gaps exist among a good number of patients but a technique called the teach-back method works well when employed properly.

“There is a gap in our understanding of health equity when it comes to healthcare-associated infections,” said Yi in the SHEA article. “Future research is needed to identify, understand, and reduce potential disparities in healthcare-associated infections related to socioeconomic status, insurance coverage, race/ethnicity, and rural residence.”