Early hospital discharge after cesarean delivery: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective The aim of this systematic review and meta-analysis was to assess whether early discharge from hospital after cesarean delivery (CD) affects the rate of maternal readmission. Data source The research was conducted using PubMed, Embase, Web of Sciences, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials as electronic databases, from the inception of each database to August 2023 with RCT as publication type. No restrictions for language or geographic location were applied. Study eligibility criteria Selection criteria included only RCTs comparing the effect of earlier versus later hospital discharge after CD. Study appraisal and synthesis methods The primary outcome was the rate of maternal readmission. The summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% confidence intervals (CI) using the random effects model of Mentel–Haenszel. I-squared (Higgins I2) greater than 0% was used to identify heterogeneity. “Early” and “late” hospital discharge was first considered according to each study's definition and then a subgroup analysis was performed including only studies defining as “early” a discharge within 24–28 hours and “late” a discharge at ≥48 hours after CD. The study was registered on PROSPERO (CRD 42024529885). Results Seven RCTs including 4,267 individuals, of which 2,125 (49.8%) randomized in the early discharge and 2,142 (50.2%) in the late discharge group were included. There was no difference between the two groups in the rate of maternal readmission (3.6% vs. 3.4%, RR 1.10; 95% CI 0.80–1.52). There was no significant difference in both maternal complications diagnosed within 6 weeks after CD and neonatal complications. Early discharge after CD was associated with improved psychological wellbeing and was cost-effective. The subgroup analysis of the primary outcomes only in high-quality studies showed similar results: no difference in the rate of maternal readmission was observed (3.8% vs. 3.2%, RR 1.20; 95% CI 0.63–2.30) between the two groups. When focusing only on studies comparing 24–28-hour versus ≥ 48-hour hospital discharge, the rate of maternal readmission did not differ between the two groups, while the rates of neonatal readmission and neonatal jaundice were significantly higher in the early discharge group. Conclusions There is no increase in the rate of maternal readmission following early hospital discharge at 24–28 hours as opposed to later hospital discharge after a CD. The rates of neonatal readmission and neonatal jaundice were significantly higher in the early discharge group. Patients undergoing uncomplicated CDs might be discharged from the hospital at 24–28 hours postpartum, as long as close neonatal outpatient follow-up is done in 1–2 days; if this is unfeasible, discharge at 48 hours seems to be safe and effective for both mother and baby. Early discharge after CD was associated with improved psychological wellbeing and was cost-effective.