Socially Vulnerable Patients Discharged Sooner After C-Section

Patients who had a C-section birth during the COVID-19 pandemic were more likely to be discharged early versus those who delivered before the pandemic, with socially vulnerable patients more commonly discharged sooner, according to a retrospective study.

Among almost 1,900 eligible deliveries, 54% of pre-pandemic cesarean deliveries had an early discharge compared with 71% of deliveries that took place during the pandemic (P<0.01), reported Ayodele Lewis, BS, of Amherst College in Massachusetts.

Social vulnerability, payer type, English-speaking ability, and multiparity were all factors that predicted whether a patient would have an early discharge, with more vulnerable patients leaving the hospital sooner (all P<0.01), Lewis noted during a presentation at the American College of Obstetricians and Gynecologists (ACOG) annual meeting, held in San Diego.

Race, as an independent variable, was not significantly predictive of whether or not a patient would have an early discharge, she said.

“Socially vulnerable patients were more likely to leave the hospital earlier than their counterparts both before and during the COVID-19 pandemic,” the authors said in their study. “Our findings suggest that increased early discharges fall disproportionately on socially vulnerable patients.”

Co-author Thomas McElrath, MD, PhD, of Brigham and Women’s Hospital in Boston, said these results show that there are disparities in hospital length of stay among obstetric patients, and more research is needed to understand how marginalized communities may be underserved.

“If you are fluent in the language and understand how hospital organizations work, you are more likely to advocate for a longer length of stay if you think you need it,” McElrath told MedPage Today. “This is potentially a mechanism by which we do see disparities occur in the healthcare system.”

McElrath added that this research supports an “organizational rethink” on decisions regarding when to send someone home after a C-section, and advocated for the establishment of objective criteria to ensure that vulnerable patients receive adequate care.

For this study, Lewis’s group compared rates of early discharge — defined as 4 days or less — for C-section births at Brigham and Women’s Hospital before and during the COVID-19 pandemic, looking at associations between length of stay and social determinants of health. They included cesarean births that occurred from January 1 to June 30, 2020, categorizing all deliveries after March 10 as pandemic births.

The group defined socially vulnerable patients as Black or Hispanic, publicly insured, or non-English speaking.

There were 1,885 deliveries included in the analysis, 694 that took place before the pandemic and 1,171 that took place during the pandemic. The median length of stay was around 95 hours (5,696 minutes, interquartile range [IQR] 4,686-6,060) for pre-pandemic deliveries, and around 76 hours (4,655 minutes, IQR 3,897-5,860) for pandemic deliveries.

Future research is necessary to determine if the higher rates of early discharge among socially vulnerable patients can be attributed to provider bias, or if it’s patient-driven, Lewis said.