Association between postoperative length of stay after cesarean delivery and postpartum maternal complications

There is no standard for how long a patient's postpartum stay should be after cesarean delivery. There are known patient- and system-level benefits of shortening the postoperative length of stay, and data are mixed on the relationship between maternal length of stay after cesarean deliveries and post-discharge complications. Our objective was to examine whether postoperative length of stay after cesarean delivery was associated with postpartum maternal complications.

We conducted a retrospective cohort study of all cesarean deliveries in 2019 in the National Surgical Quality Improvement Program database. Patients with a postoperative length of stay over 4 days postpartum were excluded, which was used as the cutoff given insurance mandate minimums. Patients were categorized based on postpartum (delivery to discharge) length of stay: 0-2, 3, and 4 days. Our primary outcome was a composite of maternal complications defined by hospital readmission, reoperation, and death up to 30 days postpartum. Outcomes were compared between the exposure groups, and multivariable logistic regression was used to estimate the association between postoperative length of stay and study outcomes using 4 days as the referent.

Of the 13,540 patients with a cesarean delivery, 8325 (61.6%) had a postoperative length of stay of 0-2 days, 4173 (30.8%) of 3 days, and 1042 (7.7%) of 4 days. Patients with a postoperative length of stay of 2 or fewer days tended to be younger and have lower rates of cigarette use, diabetes, unscheduled cesarean delivery (vs. scheduled), hypertension, general anesthesia, and American Society of Anesthesiologists class 3 or 4. Compared with a 4-day postoperative length of stay, patients with 0-2 days postoperative length of stay had significantly decreased odds of the primary composite outcome, as well as readmissions and reoperations. Compared with a 4-day postoperative length of stay, patients with a 3-day postoperative length of stay had similar odds of the primary outcome.

In this national patient sample, early postpartum discharge after cesarean was not associated with increased odds of a composite of postpartum maternal complications including maternal death, readmissions, or reoperations. Patient who were discharged early did not have an increased odds of maternal complications; this may be due to being intrinsically lower risk or due to being deemed appropriate by their caring physicians. Further studies using databases including obstetric-specific data are needed.