Factors affecting hospital length of stay after cesarean delivery

While federal laws mandate that health insurers may not restrict mothers’ hospital benefits following a cesarean section (CS) to less than 96 hours, women are often medically ready for hospital discharge sooner. The objective of this study was to identify factors affecting hospital length of stay (LOS) after CS. In preparation for initiating an Enhanced Recovery after Surgery (ERAS) protocol for CS, an anonymous one-page survey was distributed to all postpartum women on the day of hospital discharge over a two month period. Demographic, medical history and obstetric data were obtained. Factors assessed included age, parity, prior obstetrical history, breastfeeding, surgical or medical complications and obstetric provider recommendations. Women who were discharged 3 nights after CS (POD3) were compared to those discharged after 4 nights (POD4). Chi square was used for statistical analysis. Of 103 surveys collected, 48.5% were multiparous, 56.9% were >35 years old, 33.3% had a CS, 19% had a prior CS and 90.3% had private health insurance. Of the patients who had a CS, 48.6% were discharged on POD3 and 51.4% on POD4. 75.2% of the patients reported that their doctor discussed expected LOS during a prenatal visit. When comparing the two groups, POD3 patients were significantly more likely to have been advised a 3 night stay compared to POD4 patients (p=0.04). Conversely, POD4 patients were more often advised to stay up to 4 nights (p=0.04). Women with a planned CS, who exclusively breastfed and were >35 years old were more likely to go home on POD3 (Table 1). Medical or surgical complications, pain assessment, insurance status, shared room or newborn rooming-in did not differ between the two groups. LOS after CS was shorter in older women, women with a planned CS and those exclusively breastfeeding. LOS also appeared to be strongly influenced by the expectations set by the obstetric provider during the antenatal visits prior to the CS.