Hospitalization Duration Following Uncomplicated Cesarean Delivery: Predictors, Facility Variation, and Outcomes

• Main Authors: Jerome J. Federspiel, Sunitha C. Suresh, Kristin C. Darwin, Linda M. Szymanski
• Format: Article
• Language: English
• Published: Thieme Medical Publishers, Inc. 2020-04-01
• Series: American Journal of Perinatology Reports
• Subjects: cesarean section/economics; cesarean section/utilization; pregnancy; cesarean delivery; length of stay; readmission; facility variation
• Online Access: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1709681

Abstract Objectives This study was designed to: (1) characterize stay duration following cesarean delivery, (2) ascertain whether facility variation exists, and (3) determine whether shorter stays are associated with rates of readmission or costs. Study Design The 2017 Nationwide Readmissions Database was used to identify uncomplicated cesarean deliveries. Hierarchical logistic regression was used to assess for facility variation in percentage of patients discharged within 2 days. Similar models were used to assess for associations between probability of readmission within 30 days and facility-level rates of discharge within 2 days. Results In total, 456,312 patients from 1,535 hospitals were included. The median facility discharged 46.8% of patients within 2 days, with the 25th percentile of hospitals 23.7% and the 75th percentile 71.2%. In adjusted regression, there was significant facility heterogeneity (p < 0.0001). The overall readmission rate was 1.7%, and proportion of patients discharged within 2 days of cesarean delivery was not associated with readmission probability (adjusted relative risk: 1.02, confidence interval: 0.90–1.16), but was associated with lower inpatient costs (adjusted incremental cost: $111, confidence interval: −181 to −41). Conclusion Unexplained facility variation in percentage of patients discharged within 2 days of cesarean delivery was not associated with differences in readmissions. Key Points We find significant facility-level variation in outcomes following uncomplicated cesarean delivery in the United States. High rates of early (postoperative day 2) discharge was not associated with differences in readmission rates in adjusted analyses but was associated with lower inpatient costs.