(890) Clinical Risk Score for Predicting Relaparotomy After Cesarean Delivery: A Multicenter Study

Objective:
To develop and validate a clinical risk score for predicting relaparotomy within 30 days after cesarean delivery (CD), based on a large multicenter cohort.

Study Design:
We conducted a retrospective cohort study including 79,578 women who underwent CD at four tertiary centers between January 2012 and December 2022. Of these, 228 cases of relaparotomy were identified (0.3%). A predictive risk model was derived from a subset of 11,693 women (228 cases and 11,465 controls). We developed a clinical risk score by assigning weighted points to variables based on scaled β-coefficients from a multivariable logistic regression model. Eight variables were selected based on predictive strength and practical applicability: maternal age ,BMI at delivery, parity, preterm delivery (< 37 weeks), multifetal gestation, number of prior CDs, emergency CD, and APGAR score at 1 minute. Points were assigned to each variable based on relative risk weights, resulting in a score ranging from 0 to 140. Patients were stratified into three risk groups: low (< 25), medium (25–45), and high ( >45).

Results:

Among the 11,693 patients included, 44.0% were classified as low risk with a relaparotomy rate of 0.84% (43/5,145), 34.0% as medium risk with a rate of 2.54% (101/3,980), and 22.0% as high risk with a rate of 3.27% (84/2,568). Compared to the low-risk group, medium-risk patients had 3.02-fold higher odds of relaparotomy (2.54% vs. 0.84%), and high-risk patients had 3.89-fold higher odds (3.27% vs. 0.84%, p< 0.001).
Figure 1 summarizes variable weights and maximum contributions. Parity, emergency CD, and preterm delivery showed the strongest individual discrimination (AUC = 0.600, 0.590, and 0.560, respectively).

Conclusion:
The proposed score demonstrated meaningful clinical stratification, with relaparotomy rates rising progressively across risk categories. Medium and high-risk groups showed significantly higher odds or reoperation. Given the severity of relaparotomy as a rare but potentially life-threatening complication, this proposed tool offers valuable insight for early risk identification and proactive management.