Problem: Patient satisfaction, inpatient VAS pain scores, and hospital length of stay have become centralconcepts for the triple aim and CMS reimbursement schedules.1 The goal of our study was to explore these outcomes in Labor and Delivery when using Epidural PCA infusions post-Cesarean section. The outcomes we measured included post-op length of stay and post-op VAS pain scores, which we compared to the duration of PCA infusion post-C-section. Our hypothesis was that the duration of PCA infusion after the surgery has no correlation to these outcomes.
Methods: We completed a retrospective study of 198 ASA 1-2 patients who underwent
uncomplicated Cesarean sections at NYU Langone Medical Center from March to June 2015 after receiving IRB approval. The time (in hours) between the end of the c-section to the epidural removal was recorded, as well as the time (in hours) between the end of the c-section to discharge from the hospital. The epidural infusion durations post-Cesarean were grouped into 0-24h, 24-48h, and 48-72h post op. These sets were compared to the average VAS pain scores as documented by RN’s caring for the patient as well as the time to discharge.
Results: Of the 198 patients, 35 had their epidural removed <24 hrs after their c-section, compared to 163 patients who had it removed >24 hours afterwards. The <24hrs group had an average hospital length of stay of 75.7 hours postop compared to 82.2 hours in the >24hours group (p=0.024). When we compared the average VAS pain scores between the early and late epidural removal groups, we found them to be 2.39 v 2.08, p=0.07 (0-24h postop), 2.65 v 2.40, p=0.14 (24-48h), and 2.79 v 2.95, p=0.26 (48-72h).
Discussion: Our study found a statistically significant correlation between early epidural catheter removal and earlier hospital discharge, with those having the epidural removed hours earlier than those with their epidural removed >24hrs postop. While VAS pain scores were better for the longer EPCA infusion group for the first 48 hours postop, these results were not statistically significant. The reasons for these results can be multifactorial. A longer EPCA duration may lead to a greater sense of comfort for the patient and decreased sense of urgency to be discharged. Also, later EPCA removal times may delay the time needed to ensure the patient is stable on an oral pain medication regimen before going home. Finally, it may be the case that patients with greater perception or sensitivity to pain may be more reluctant to have their epidural catheter removed, and these patients may have had the same length of stay (or even longer) had the catheter been removed earlier. A randomized clinical trial, with a greater number of patients, may be needed to help provide more information on this topic.