Postpartum Readmission: Risk Factors And Diagnoses

To identify complications during the delivery hospitalization most strongly associated with postpartum readmission and the most common readmission diagnoses. Retrospective cohort study of singleton births from Jan 2017 - June 2019 (23+0-43+6 weeks’ gestation) at 17 hospitals participating in a perinatal quality collaborative. Postpartum readmission was defined as readmission to the delivery hospital within 30 days. Patient characteristics, pregnancy complications, and readmission diagnoses were abstracted from the medical record. Multivariate logistic regression modeling with clustering by hospital was used to assess the risk of postpartum readmission in women with specific complications during the delivery hospitalization, including cesarean birth, antepartum hypertensive disease of pregnancy (HDP), new postpartum diagnosis of preeclampsia, severe hypertension, blood transfusion, and severe maternal morbidity (SMM) excluding blood transfusion (exposure groups). Covariates included parity, maternal age, body mass index (BMI), and commercial insurance status. Of 63,512 women with singleton births, 1.4% (n=923) were readmitted. The most common readmission diagnoses were HDP (52.4%) and infectious complications (23.4%). All delivery hospitalization complications of interest were associated with increased odds of readmission and remained so after adjustment for covariates (Table 2). Severe hypertension, new diagnosis of postpartum preeclampsia, and SMM without blood transfusion had the highest odds of readmission (aOR = 14.8, CI: [5.63, 38.7], aOR = 4.85, 95% CI: [3.19, 7.38] and aOR = 5.05, 95% CI: [2.63, 9.70], respectively). Hypertensive disorders (particularly severe hypertension and a new diagnosis of postpartum preeclampsia) and SMM during the delivery hospitalization conferred the greatest increase in the risk of readmission. More than half of all 30-day readmissions were for hypertension. Individualized postpartum management including discharge timing and follow-up for these women is critical to reducing readmissions.View Large Image Figure ViewerDownload Hi-res image Download (PPT)