TITLE:
Time Course of Postoperative Complications in Low-Risk Women after Planned Cesarean Section
AUTHORS:
Anne Raabjerg Kruse, Linn Håkonsen Arendt, Christian Erikstrup, Ulrik Schiøler Kesmodel, Finn Friis Lauszus, Niels Uldbjerg, Iben Sundtoft, Axel Forman
KEYWORDS:
Cesarean Section, Postoperative Complications, Postoperative Hemorrhage, Early Discharge, Length of Hospital Stay
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.12 No.5,
May
25,
2022
ABSTRACT: Objectives: Length of hospital stay after cesarean section is
today much shorter than previously, and a stay of only 1 day is used in many
departments. However, complications requiring immediate treatment must be
diagnosed before leaving hospital. We assessed the time interval from planned
cesarean section to diagnosis of major complications in low-risk women to
estimate a safe time of discharge. Methods: We performed a retrospective observational study
among 5633 women undergoing planned cesarean section from 2001-2017 at
Aarhus University Hospital, Denmark. The inclusion criterion was postoperative
complication graded as Clavien-Dindo ≥ II. Exclusion criteria were preoperative
comorbidity or problems during surgery indicative of need for prolonged stay.
Time from cesarean section to suspicion of a postoperative complication was the
primary endpoint. Results: The study population consisted of 116 women with unexpected
postoperative complications, 47 classified as Clavien-Dindo II and 69 as
Clavien-Dindo III-IV. In 63 of the 116, the diagnoses were suspected within 24 hours
(Clavien-Dindo II: 25, Clavien-Dindo III-IV: 38).
These included all cases of relaparotomy and uterine atony with immediate need
of medical treatment. Acute colonic pseudo-obstruction was diagnosed within 2
days, while other complications were suspected and treated 2 to 10 days
postoperatively. Conclusions: Among low-risk women with a postoperative complication, all cases
requiring relaparotomy and medically treated uterine atony were suspected
within 24 hours after surgery. Discharge 24 hours after planned cesarean
section seems safe in low-risk patients.