Maternal Outcomes Based on Inpatient Length of Stay After Cesarean Delivery Using the NSQIP Database

INTRODUCTION: Cesarean deliveries (CD) are common surgeries performed in the U.S., yet a patient’s postpartum length of stay (LOS) is not standardized and is influenced by multiple factors. We sought to examine whether postpartum maternal outcomes differ based on post-cesarean LOS. METHODS: Retrospective cohort study of all CDs from 2019 in the National Surgical Quality Improvement Program database. Patients with a LOS >4 days postpartum were excluded. Patients were categorized based on postpartum LOS: 0–2, 3, and 4 days. Our primary outcome was a composite of maternal complications including hospital readmission, reoperation, and death, up to 30 days postpartum. Outcomes were compared between the LOS exposure groups and adjusted odds ratios calculated using 4 days as the reference. RESULTS: Of 9,959 patients, 6,288 (63%) had a LOS of 0–2 days, 2,901 (29%) 3 days, and 770 (8%) 4 days. At baseline, the LOS groups differed in terms of maternal age, race, tobacco use, diabetes, hypertension, and type of surgical case. Compared to a 4-day LOS, patients with LOS 0–2 days had significantly decreased odds of composite maternal complications (aOR, 0.5; 95% CI, 0.3–0.7), as well as readmissions (aOR, 0.6; 95% CI, 0.4–0.9) and reoperations (aOR, 0.3; 95% CI, 0.2–0.5). Patients with a 3-day LOS (versus 4 days) only had reduced reoperations (aOR, 0.5; 95% CI, 0.2–0.9). CONCLUSION: Discharge earlier than 4 days postpartum did not show an increased risk of maternal complications, readmissions, or reoperations. The selection of low-risk patients for early discharge does not appear to be harmful, and policies requiring prolonged hospitalization for all patients are likely unnecessary.