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CC BY-NC-ND 4.0 · AJP Rep 2020; 10(02): e187-e197
DOI: 10.1055/s-0040-1709681
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Authors

  • Jerome J. Federspiel 

    1   Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
    2   Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina

  • Sunitha C. Suresh

    1   Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
    3   Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois

  • Kristin C. Darwin 

    1   Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland

  • Linda M. Szymanski

    1   Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
    4   Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota

Funding Howard A. Kelly Resident Research Grant from the Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine.
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Publikationsverlauf

08. Dezember 2019

05. März 2020

Publikationsdatum:
19. Juni 2020 (online)

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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.

Keywords

cesarean section/economics - cesarean section/utilization - pregnancy - cesarean delivery - length of stay - readmission - facility variation

Note

A preliminary version of this report was presented in poster form at the 38th Annual Society for Maternal-Fetal Medicine Annual Pregnancy Meeting (January 29–February 3, 2018 in Dallas, TX).


This research was funded by a Kelly Resident Research Award from the Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine. The funding source was not involved in the conduct of this research or preparation of this report.