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Risk factors for prolonged length of stay after cesarean delivery
Abstract Number: T-56
Abstract Type: Original Research
Introduction: Rising rates of cesarean delivery (CD) have been linked to increases in severe obstetric morbidity.(1) However, the impact of pre- or perioperative morbidities on hospital length of stay (LOS) after CD is unclear. Using a CD registry, our aim was to identify risk factors for prolonged LOS among women undergoing CD.
Methods: Women undergoing CD were sourced from a US (NICHD MFMU Network) registry of 19 academic centers between 1999-2002.(2) Prolonged LOS was defined as a postpartum hospitalization duration ≥90th centile.(1) We compared maternal, obstetric and neonatal variables between women with vs. without prolonged LOS. Unadjusted and adjusted multiple logistic regression analyses were performed. Candidate variables that were associated with prolonged LOS on univariate analysis (P ≤ 0.1) were included as covariates in a multivariate logistic regression analysis using a traditional backward model selection.
Results: In our cohort, 57067 women underwent CD and 6122 (10.7%) women had prolonged LOS. In our study, a LOS >6 days after CD was defined as a prolonged LOS. Candidate variables independently associated with prolonged LOS are presented in Table. The following perioperative complications had the highest independent risk for prolonged LOS: Endometritis (aOR=9.81; 95% CI=8.84-10.89), maternal ileus (aOR=9.28; 95% CI=7.03-12.2), and wound complications (aOR=5.0; 95% CI=4.02-6.21). Several antepartum, obstetric and neonatal variables were associated with prolonged LOS including placenta previa (aOR=3.32; 95% CI=2.74-3.28), pre-eclampsia (aOR=2.99; 95% CI=2.73-3.28), preterm delivery <37 weeks (aOR=4.18; 95% CI= 3.77-4.63) and neonatal birthweight < 2500 g (aOR=3.57; 95% CI=3.01-4.23). One or ≥2 prior CDs were independently associated with lower risk for prolonged LOS compared to no history of prior CD (aOR=0.62; 95% CI=0.55-0.69).
Conclusion: Based on our results, we identified specific maternal, perinatal and perioperative morbidities associated with prolonged LOS. In order to reduce the health-care burden of prolonged LOS after CD, modified approaches are needed for optimizing the perioperative care of high-risk women undergoing CD and to reduce the incidence of perioperative complications.
References: (1) Obstet Gynecol 2009; 113: 293-9 (2) N Engl J Med 2004; 351: 2581-9.