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

Ayamo Oben; William Perez; Victoria C. Jauk; Kim Boggess; Erin Clark; George Saade; M Sean Esplin; Sherri Longo; Kirsten L. Cleary; Ronald Wapner; Sean C. Blackwell; Michelle Y. Owens; Namasivayam Ambalavanan; Jeff M. Szychowski; Alan Tita

doi:10.1055/s-0042-1743248

American Journal of Perinatology, Table of Contents

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

¹Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama

,

William Perez

¹Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama

,

Victoria C. Jauk

²Birmingham, Alabama

,

Kim Boggess

³Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina

,

Erin Clark

⁴Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah

,

George Saade

⁵Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas

,

M Sean Esplin

⁶Department of Maternal Fetal Medicine, Intermountain Medical Center, Murray, Utah

⁷Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah

,

Sherri Longo

⁸Ochsner Health System, New Orleans, Louisiana

,

Kirsten L. Cleary

⁹Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York

,

Ronald Wapner

¹⁰Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York

,

Sean C. Blackwell

¹¹Department of Obstetrics and Gynecology, University of Texas Health Sciences Center at Houston, Houston, Texas

,

Michelle Y. Owens

¹²Department of Obstetrics and Gyneclogy, University of Mississippi Medical Center, Jackson, Mississippi

,

Namasivayam Ambalavanan

¹³School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama

,

Jeff M. Szychowski

¹⁴Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama

,

Alan Tita

²Birmingham, Alabama

› Author Affiliations

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

Full Text

References

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