Objective: To audit whether hospital stay shortened without increasing readmissions after implementation of fast-track methodology for elective cesarean section and characterize what influences length of stay.

Methods: A fast-track program was initiated in November 2008, with a one year clinical audit and satisfaction survey. Discharge criteria were predefined and midwife home visits included if discharge was within 48 hours. Hospital stay by parity for women with elective section for singleton pregnancy between 1.11. 2008 – 31.10. 2009 (n=213, fast-track 182) was compared to 2003 (n=199) and 2007 (n=183). Readmissions and outpatient visits 2007 and 2008-9 were counted. Reasons for longer stay were recorded in fast-track, and body mass index.

Result: Median hospital stay decreased significantly from 81 to 52 hours between 2007 and 2008-9. Readmissions were four in each period and outpatient visit rates similar. In 2008-9, 66% of all women were discharged within 48 hours. Women in the fast-track program were satisfied with early discharge. Hospital stay for parous women was shorter in 2007 compared to 2003, but unchanged for nulliparas. Parity had a minimal influence on length of stay in 2008-9, although nulliparous women ≤25 years were more likely to stay >48 hours. Body mass index did not correlate with length of stay. Pain was rarely the reason for a longer stay in the fast-track program and 90% were satisfied with pain-medication after discharge.

Conclusion: Most healthy women can be discharged early after singleton birth by elective cesarean, without increasing readmissions.

Keywords: Cesarean section, hospital stay, fast-track surgery.

Correspondence: Jóhanna Gunnarsdóttir, johagun@bjarni.muna.is

Figure 1: Hospital stay after singleton births by elective cesarean section in November 2008  - October 2009. In fast-track 182 of 213, but 31 women did not follow the program and advised to
stay more than 48 hours. Reasons for hospital stay over 48 hours are listed for women advised to
stay longer and those who entered the enhanced recovery program but were not discharged early.

Figure 2: Shortened hospital stay after cesarean section from 2003 to 2009. Fast-track program was initiated in November 2008. Full years 2003 and 2007 was compared to November 2008 – October 2009 (one year time-span). All women with elective cesarean section except those having twins.

Figure 3: Womens satisfaction with duration of hospital stay in relation to actual time of discharge. Women in fast-track program January-May 2008-9 (n=54, *p=0,03).

Table I: Hospital stay of women with singleton pregnancies having elective cesarean section in 2008–9 (one year time-span) compared to full years 2003 and 2007. Differences in hospital stay between nullipara and parous women.  P-values: p<0.0001 between 2007 og 2008-9. Between 2003 og 2007:  Nullipara p=0.50, parous p=0.001 and all women p=0.003.

Table II: Outpatient visits and readmissions to the maternity ward before and after starting fast-track program. *p=0.22 **p=0.05