1039 Maternal transfer of care and mortality risk in obstetric patients with sepsis

Abstract

Maternal sepsis is a leading cause of maternal mortality in the United States. Management typically involves prompt treatment and possible transfer to centers with higher levels of care. There is little data on obstetric transfers with sepsis. The objective of this study was to assess sepsis transfers and associated maternal mortality. A cross sectional analysis of obstetric hospitalizations with a diagnosis of shock/sepsis was conducted using the 2008-2015 National Inpatient Sample. Patients were stratified based on whether they were directly admitted or transferred in from another acute care facility. The primary outcome was inpatient mortality. Hospitals were analyzed by location and teaching status. Log linear models were fit to determine associations between transfer status and hospital factors and inpatient mortality, adjusting for patient, clinical, year, and whether patients were hospitalized antepartum, for delivery, or postpartum. Of the 58,554 cases of maternal sepsis, there were 1,806 (3.1%) inpatient mortalities and 4,942 (8.5%) maternal transfers. Most patients were admitted during an antepartum hospitalization (49.7%) followed by during a delivery (32.9%) and postpartum (17.4%) hospitalizations. Mortality rates were higher among transfer patients (9.0% vs. 2.5%), and overall higher when stratified by hospital bed size and teaching status (Figure). Adjusted analysis noted that maternal transfers were at nearly three times higher risk of mortality (aRR 2.70, 95% CI: 2.40, 3.04) compared to non-transfers. Urban teaching, urban non-teaching, and larger sized facilities were associated with significantly higher risks of maternal mortality (Table). Maternal transfers are associated with a disproportionately higher risk of inpatient mortality in the context of other hospital factors. Earlier identification of patients with sepsis and appropriate transfers to referral centers may be important in reducing maternal death from this cause.View Large Image Figure ViewerDownload Hi-res image Download (PPT)