Time Course of Postoperative Complications in Low-Risk Women after Planned Cesarean Section

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.