Impact of Early Discharge after Planned Cesarean Section in Omdurman Maternity Hospital, Sudan

Background: Cesarean section (CS) is a common surgical operation with expected complications representing major health problems. This necessitates improved recovery with reduced hospital stay. Discharge after planned CS has become an accepted practice, however, little is known about its health impact and patient perception.

Objective: The present study aimed to assess patient satisfaction and morbidity associated with early hospital discharge (24 hours) after planned elective cesarean section- El C/S in 2010.

Methodology: A descriptive study was done in Omdurman Maternity Hospital (OMH) in 2010. All women admitted for El C/S were counseled for discharge after 24 hours from C/S; those with medical or obstetrical problems necessitating admission for a longer time were excluded. Women who refused to be discharged were included as control after informed consent. All women were operated on by trained registrars or consultants under similar conditions and were followed till discharge from the hospital.

Results: Elective cesarean section had potential benefits for the mothers and their babies; such as reducing birth asphyxia, birth trauma, cord accidents, fresh stillbirth (FSB), and birth canal injuries to the mother, however, it is not without complications. Total number of deliveries in OMH during 2010 was 28975, 21022 (72.6%) delivered vaginally, 7953 (27.4%) delivered by cesarean section –C/S, El C/S were 3204 (11.1%) and Em C/S were 4749 (16.4%). Women included in the study were 1439, 716 (49.8%) were in the study group and 723 (50.2%) were in the control. Forty-one cases (2.8%) were readmitted after discharge, fifteen (1.1%) from the study group and twenty-six (1.8%) from the control. Twenty-four cases (1, 7%) due to wound infection, five (0.3%) with deep vein thrombosis- DVT, two with endometritis, and eight (0.6%) due to non-pregnancy-related infection. Although there is a slight increase in the rate of readmission, wound infection, and DVT in the control group, there is no significant difference between the two groups. In the study group, 613 (85.6%) were satisfied with a short stay, while in the control group, 269 (37.2%) were satisfied with a longer hospital stay after El C/S (PV = 0.0001) with a significant difference between the two groups.

Conclusion: Discharge after 24 hours following planned C/S can be performed on low-risk patients without affecting patient satisfaction and increase in maternal mortality or morbidity. More randomized trials are needed to assess the impact of standard care.