POST-OPERATIVE MANAGEMENT OUTCOMES IN UNCOMPLICATED CAESAREAN DELIVERY: THE SHORT STAY VERSUS TRADITIONAL PROTOCOL IN THE LAGOS UNIVERSITY TEACHING HOSPITAL, NIGERIA

Abstract

Introduction: The current trend towards early discharge from hospital following Caesarean
delivery has led to increasing interest in patients’ post-operative management allowing for quick
recovery and return to function. Caesarean delivery is presently the most commonly performed
major obstetric procedure, and duration of hospital stay following the procedure varies from
centre to centre. There is therefore need to examine the physical, psychological, social and
economic implications of length of hospital stay following the procedure, towards demystifying
it, especially in parts of the world that still reserve some misgivings about this operation.
Aim: To determine the differences in safety, quality of care (emphasis on patient satisfaction)
and cost; between the short stay and traditional post-operative management protocol, following
uncomplicated Caesarean delivery.
Materials and Methods: A randomized controlled clinical trial done in the Lagos University
Teaching Hospital, Nigeria. Two hundred women for elective Caesarean delivery were
randomized into the short stay and traditional groups (using computer generated random
numbers). The women in the short stay group were ambulated from 6 hours post-operative; oral
intake initiated at 6 hours (regular diet commenced at 24 hours) post-operative; and urethral
catheter discontinued 12 hours post-operative. The traditional group was managed according to
usual protocol: ambulating from 12 hours, oral intake initiated and urethral catheter discontinued
at 24 hours post-operative. Posture (erect or not) and pain scores of subjects were recorded at 72
hours post-operative. In the short stay group, the wounds were inspected and exposed on the
third day post-operative, and the patient subsequently discharged. In the traditional group, the
wound was inspected and exposed and patient discharged on the fifth day post-operative.
All subjects were monitored for fever in the first 10 days post-operative (excluding first 24
hours), clinical signs of wound sepsis, urinary tract infection and puerperal sepsis developing in
the first 2 weeks after surgery. Hospital bills were recorded, patients’ level of satisfaction with
care were noted at the 2 weeks postnatal visit; and rate of readmission to hospital in the first 6
weeks after delivery was recorded.
Results: There was no maternal mortality recorded during the study in both groups, and there
was no significant difference in febrile and infective morbidity, erect postures and readmission
rates between the two groups. Women in the short stay group had significantly lower pain scores
(t=4.75, p<0.001), higher level of satisfaction with care (t=7.19, p<0.001) and lower hospital
bills (t=5.53, p<0.0001), than the traditional group.
Conclusion: There is no difference in safety outcomes between the short stay and traditional
post-operative management protocols following uncomplicated Caesarean delivery. Quality of
care (in terms of patient satisfaction) and cost-effectiveness seems better in the short stay than
the traditional protocol group.
Recommendation: Hospitals may adopt the short stay post-operative management protocol
following uncomplicated Caesarean delivery, towards reducing healthcare costs and
demystifying the operation.

POST-OPERATIVE MANAGEMENT OUTCOMES IN UNCOMPLICATED CAESAREAN DELIVERY: THE SHORT STAY VERSUS TRADITIONAL PROTOCOL IN THE LAGOS UNIVERSITY TEACHING HOSPITAL, NIGERIA