Early versus routine hospital discharge after uncomplicated caesarian delivery at Kijabe hospital

Abstract

Background: Caesarian delivery is a major operation in Obstetrics and outcomes and complications are major concerns for the beneficiaries and health providers. The average hospital stay following C/s in most hospitals in Kenya is three to four days, a tradition not supported by any evidence, policy or practice guidelines. Over the years, mainly in high income countries, it’s becoming common practice to discharge patients early to satisfy their wishes, reduce cost and also reduce work load in high patient turn-over settings. Objective: The study was intended to determine if discharge from hospital on day two postoperatively after uncomplicated Caesarian delivery was satisfactory to women and to determine to what extent it was followed by adverse clinical maternal outcomes at Kijabe Hospital. Study design: This was a randomized clinical trial(unblinded) where the intervention group consisted of patients discharged on day two and the control group as those discharged on routine day three postoperatively after uncomplicated C/s. The primary outcome variables were patient satisfaction, wound infection and maternal readmission rates. Methods: The study population consisted of patients who had uncomplicated Caesarian delivery at Kijabe Hospital randomized into two groups: day 2 and routine day 3 discharge. Data was extracted from patient records and also from patient interviews by the principal investigator using a structured questionnaire. Results: From June to October 2014, 171 patients were randomized; 90 to day 2 and 81 to day 3 hospital discharge. The study population encompassed women with a mean age of 29.4 years. Most of them were married, had attained a college level education and were self-employed. The majority were also immuno-competent. We found increased satisfaction among early hospital discharge of the patients (95.6% vs. 71.6%, p=0.001, 95% CI 83.4(78.4-93.6) without increased adverse maternal outcomes: wound infection rate (0.0% vs. 1.2%, p=0.290, 95% CI 0.6(0.0-2.1) or readmission rates (1.1% vs. 0.0%, p=0.341, 95% CI 0.5(0.0-1.7). Conclusion & Recommendations: Day 2 hospital discharge is associated with significant patient satisfaction and with no significant adverse maternal outcomes. Therefore day 2 hospital discharge is acceptable, feasible, safe, sustainable and likely to be cost-effective. Therefore, early hospital discharge after uncomplicated Caesarian delivery should be considered as an alternative to day 3 discharge.