Readmission following caesarean section: Outcomes for women in an Irish maternity hospital
Women who give birth by caesarean section are more likely to require readmission to hospital following birth compared to women who give birth vaginally.
To examine the reasons, management and outcomes for women readmitted to hospital following birth by caesarean section (CS).
A retrospective audit of maternity records was undertaken.
The total number of births for the period of data extraction was 8580, of which 2470 (28.79%) women gave birth by CS. A total of 107 women (4.33% of those who gave birth by CS) were readmitted to hospital between 1 August 2014 and 31 July 2015, of which 46 women (1.86%) were readmitted following elective CS and 61 (2.47%) following emergency CS. The average length of hospital stay was 2.64 and 4.61 nights, respectively, and the average timeline for readmission was 14.6 days following elective CS and 15.7 following emergency CS. The most common reason for readmission was wound infection, with the majority of women requiring analgesics (n=29, 63.05% following elective CS and n=51, 83.61% following emergency CS) and intravenous antibiotics (n=23, 50% following elective CS and n=34, 55.74% following emergency CS).
Abdominal wound infection is one of the most common reasons for readmission of women to hospital following birth by CS. These findings will make it easier to understand and identify women at risk of postpartum morbidity following birth by CS.
Clinical audit has been regarded as a valuable asset to examine existing practices with an aim to improve quality of health care in future (Johnston et al, 2000). Rising rates of caesarean section (CS), with no improvements in maternal and neonatal morbidity, are a global concern (Zeitlin et al, 2013), and there is considerable variation from one country to another (Macfarlane et al, 2016).
Readmission to hospital following birth is considered to be a key indicator of maternal health (Lydon-Rochelle et al, 2000) and has been listed as one of the top 10 maternity care core outcome measures in a multinational Delphi survey (Devane et al, 2007). Women giving birth by CS are more than twice as likely as those who give birth vaginally to require readmission to hospital within 30 days of birth, primarily due to wound complications (Lydon-Rochelle et al, 2000; Thompson et al, 2002). Readmission to hospital post-CS was estimated to increase the cost of health care by 13% compared to readmission following vaginal birth, in a study of 244 088 women in Massachusetts, USA (Declercq et al, 2007). Analysis of data from 900 108 births in Canada for the years 1997/98 and 2000/01 showed that birthing by CS was associated with a fivefold increase in cardiac arrest (1.9% versus 0.4%), a fourfold increase in wound haematoma (13.0% versus 2.7%), a threefold increase in infection (6.0% versus 2.1%) and haemorrhage resulting in hysterectomy (0.3% versus 0.1%), and a twofold increase in anaesthetic complications (5.3% versus 2.1%) (Liu et al, 2007). Increased maternal and neonatal morbidities are associated with emergency CS, as well as when CS is performed without any medical indication (Karlström et al, 2013). The total cost of ‘excess’ CS in 2008, worldwide, was estimated to be approximately 5.4 times the cost of the ‘needed’ procedures (Gibbons et al, 2010).
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