Download PDF
Am J Perinatol 2022; 39(10): 1042-1047
DOI: 10.1055/s-0042-1743248
SMFM Fellowship Series Article

Timing of Maternal Discharge after Cesarean Delivery and Risk of Maternal Readmission

Ayamo Oben
1   Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama
,
William Perez
1   Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama
,
Victoria C. Jauk
2   Birmingham, Alabama
,
Kim Boggess
3   Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
Erin Clark
4   Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
,
George Saade
5   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
M Sean Esplin
6   Department of Maternal Fetal Medicine, Intermountain Medical Center, Murray, Utah
7   Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
,
Sherri Longo
8   Ochsner Health System, New Orleans, Louisiana
,
Kirsten L. Cleary
9   Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
,
Ronald Wapner
10   Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
,
Sean C. Blackwell
11   Department of Obstetrics and Gynecology, University of Texas Health Sciences Center at Houston, Houston, Texas
,
Michelle Y. Owens
12   Department of Obstetrics and Gyneclogy, University of Mississippi Medical Center, Jackson, Mississippi
,
Namasivayam Ambalavanan
13   School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
,
Jeff M. Szychowski
14   Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
,
Alan Tita
2   Birmingham, Alabama
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective Despite legislation and hospital policies (present in some institutions) mandating a minimum length of stay in an effort to decrease the frequency of hospital readmissions, the effectiveness of this approach remains uncertain.

We hypothesized that following cesarean delivery (CD), the rates of maternal readmission or unscheduled health care visits are lower in patients discharged on postoperative day (POD) 3 or ≥4 as compared with those discharged earlier on POD 2.

Methods This is a secondary analysis of a multicenter randomized trial comparing adjunctive azithromycin for unscheduled CD to prevent infection. Groups were compared based on the duration of hospitalization measured in days from delivery (POD 0) to day of discharge and categorized as POD 2, 3, and ≥4. The primary outcome was the composite of any maternal postpartum readmission, unscheduled clinic, or emergency room (ER) visit, within 6 weeks of delivery. Secondary outcomes included components of the primary outcome and neonatal readmissions. We excluded women with hypertensive disorders of pregnancy and infections diagnosed prior to POD 2.

Results A total of 1,391 patients were included. The rate of the primary outcome of any readmission increased with POD at discharge: 5.9% for POD 2, 9.4% for POD 3, and 10.9% for POD ≥4 group (trend for p = 0.03). The primary outcome increased with later discharge (POD ≥4 when compared with POD 2). Among components of the composite, ER and unscheduled clinic visits, but not maternal readmissions, increased with the timing of discharge for patients discharged on POD ≥4 when compared with POD 2. Using logistic regression, discharge on POD 3 and on POD ≥4 was significantly associated with the composite (adjusted odds ratios [aOR] 2.6, 95% confidence interval [CI] [1.3–5.3]; aOR 2.9, 95% CI [1.3–6.4], respectively) compared with POD 2.

Conclusion The risk of maternal readmission composite following uncomplicated but unscheduled CD was not lower in patients discharged home on POD 3 or ≥4 compared with patients discharged earlier (POD 2).

Key Points

  • Risk of maternal readmission is higher in patients discharged on POD 3 or 4 compared with POD 2.

  • No significant differences by the timing of discharge were observed for any neonatal readmissions.

  • Timing of discharge should include an individualized approach with the option of discharge by POD 2.

Keywords

hospital discharge - unscheduled cesarean delivery - maternal readmissions - neonatal readmissions


Publication History

Received: 17 March 2021

Accepted: 25 January 2022

Article published online:
04 March 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA