Risk Factors for Prolonged Postpartum Length of Stay Following Cesarean Delivery

Abstract

Objective This study aims to identify risk factors for prolonged postpartum length of stays (LOS) after cesarean delivery (CD). Study Design Patients undergoing CD were sourced from a multicenter registry of 19 academic centers between 1999 and 2002 (n = 57,067). Prolonged postpartum LOS was defined as a hospitalization duration ≥ 90th centile. Maternal, antepartum, perioperative, and neonatal variables were compared between women with and without prolonged postpartum LOS. Results The 90th centile for postpartum LOS was 4 days, with 14,954 women experiencing prolonged postpartum LOS. Women with perioperative complications had the highest independent risk for a prolonged postpartum LOS: ileus (adjusted odds ratio [aOR] = 12.28; 95% confidence interval CI = 8.98–16.8); endometritis (aOR = 10.45; 95% CI = 9.51–11.5), and wound complications (aOR = 5.49; 95% CI = 4.54–6.63). Several antepartum, perioperative, and neonatal variables were associated with a prolonged postpartum LOS. Conclusion Perioperative complications had the highest risk for prolonged LOS after CD. Strategies to reduce perioperative complications are needed to decrease the health care burden of prolonged post-CD LOS.

Length of stay after childbirth in India: a comparative study of public and private health institutions

“…The growing cost of hospital stays is one of the factors for early discharge [36]. In addition to this, Blumenfeld found that younger and older women (less than 20 years or more than 34 years of age) who have insurance are more likely to stay for long after birth [2].…”

“…Global efforts to prevent maternal and perinatal mortality aim to ensure all women have access to skilled attendants for childbirth, which in practice is synonymous with advocating for both facility delivery and home birth. In the twentieth century, a higher proportion of births occurred in a facility/hospital than at home [1][2][3]. The maternal mortality ratio (MMR) in India had declined by 124 points from 254 maternal deaths per 100,000 live births in 2006 to 130 in 2016 [4].…”

“…The extent to which women receive such care is directly related to the length of their postpartum stay. Postpartum length of stay after vaginal delivery has been identified as an essential quality indicator of woman care [2,13,14]. The length of stay after cesarean delivery may also be important for evaluating the quality of peripartum and postpartum obstetric care.…”

Dealing with highly skewed hospital length of stay distributions: The use of Gamma mixture models to study delivery hospitalizations

“…The limitation in the choice of covariates and not being able to include health status information likely lead to the underestimation of the mean LOS. Individual patient comorbidities are unlikely to substantially change prediction of components (shorter LOS and longer LOS distributions) [40,41]. As with modeling in general the effect of a parameter changes depending on the other covariates in the model.…”

Prevalence of Postpartum Endometritis and Antimicrobial Resistance of Responsible Pathogens in Ukraine: Results a Multicenter Study (2015-2017)

“…Bacterial infections during labour and the puerperium are among the leading causes of maternal morbidity and mortality worldwide [1,2]. Postpartum endometritis is the most common infectious complications following childbirth and occurs in women from 1% to 30% [3][4][5][6][7][8][9]. This infection is more common after cesarean section than with vaginal delivery [10].…”