1073: Timing of discharge after cesarean delivery and maternal readmissions

Abstract

Legislation in some states mandate a minimum hospital stay of 4 days following cesarean delivery (CD) to minimize complications after discharge. We hypothesize that following CD, the risk of maternal readmission or unscheduled visits is no less in those discharged on post-operative day (POD) 3 or at least 4 days (4+) compared to those discharged on POD2. Secondary analysis of data from a multi-center, randomized trial of adjunctive azithromycin vs. standard cefazolin to prevent infection in women undergoing unscheduled CD. Pregnancies complicated by infection before POD2 or by hypertensive disorders of pregnancy were excluded. The exposure was categorized as POD 2, 3 and 4+. The primary outcome was the composite of any maternal readmission, ER visit or unscheduled clinic visit within 6 weeks of CD. Secondary outcomes were neonatal readmission rates. The chi-square test of trend examined outcome rates across groups and multivariable logistic regression modeled outcome odds while adjusting for potential confounders. Of 1421 eligible women, 293 were discharged on POD2, 722 on POD3 and 406 on POD4+ (Table 1). Timing of hospital discharge mirrored trends in several patient characteristics (Table 1). As timing of hospital stay increased from POD2 to 4+, the composite of readmission or unscheduled visits (Table 2) increased from 5.8% to 11.1% (p trend< 0.01). The pattern generally remained the same after adjusting for differences in characteristics relative to POD2: aOR 2.4 for POD 3 and 2.7 for POD 4. Infections accounted for the majority for readmissions. Neonatal readmissions did not show similar patterns. Under usual care for unscheduled CD, maternal readmission or unscheduled visits were no less frequent following discharge on POD 3 or POD4+ compared to POD2; in fact longer stay was inherently associated with a higher chance of readmission. These data do not support mandating a minimum hospitalization period of up to 4 days for CD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)