Incidence of and risk factors for new pain diagnoses after cesarean delivery: a retrospective cohort study using the Premier Healthcare Database (2016-2020)

Int J Obstet Anesth. 2026 Jun 25;67:105225. doi: 10.1016/j.ijoa.2026.105225. Online ahead of print.

ABSTRACT

BACKGROUND: Cesarean delivery is common in the United States, but the incidence of persistent pain after cesarean is not well elucidated. This study aimed to examine the incidence of new pain diagnoses in the 3-12 months after cesarean delivery.

METHODS: This retrospective cohort study included patients aged 12-55 years who underwent cesarean delivery from 2016 to 2020 in Premier Healthcare Database, a national administrative database covering all payors. Patients with pre-existing chronic pain, pre-existing opioid use disorder, maternal death during birth hospitalization, or no pre-delivery encounter were excluded. The primary outcome was new pain diagnoses at a subsequent encounter 3-12 months after cesarean delivery, defined by new ICD-10 pain codes. Associations with clinical variables were assessed using multivariable logistic regression with robust variance estimators.

RESULTS: Of 668,898 patients, 15,536 (2.3%; 95% CI 2.29-2.36%) had new pain diagnoses after cesarean delivery. New pain diagnoses were associated with general anesthesia versus neuraxial (OR 1.22, 95% CI 1.14-1.31), pre-existing substance use disorder, (OR 1.25, 1.18-1.32), anxiety (OR 1.27, 1.19-1.37), depression (OR 1.16, 1.07-1.26), Black race (OR 1.28, 1.22-1.34), preterm delivery (OR 1.19, 1.13-1.25), BMI ≥40 kg/m² (OR 1.35, 1.28-1.45), and blood transfusion (<4 units OR 1.19, 1.09-1.29; ≥4 units OR 1.28, 1.07-1.54).

CONCLUSION: In this national cohort, 2.3% of patients had new pain diagnoses 3-12 months after cesarean delivery. This rate reflects coded diagnoses in patients returning to the Premier system rather than the patient-experienced burden of persistent pain after cesarean delivery.

PMID:42391681 | DOI:10.1016/j.ijoa.2026.105225