280: Timing of postpartum readmissions and risk for severe maternal morbidity

Abstract

While the postpartum visit typically occurs 6 weeks after delivery, many common complications requiring readmission occur sooner. Both the temporal distribution of postpartum readmissions and risk for severe morbidity during readmissions are poorly characterized. The objective of this analysis was to analyze risks for readmission and severe morbidity based on time from delivery hospitalization discharge. Using the 2010-2014 Nationwide Readmission Database, we identified delivery hospitalizations and 60 -day all-cause readmissions. Readmissions were categorized based on days from delivery hospitalization discharge: ≤10, 11-20, 21-30, 31-40, 41-50, 51-60 days. We evaluated risk for severe maternal morbidity (SMM) during these readmissions using criteria from the CDC. Multivariable log linear regression analysis with risk ratios (RR) as the measures of effect was performed to determine the relationship between when readmission occurred and risk for SMM. Between 2010-2014, 254,668 readmissions occurred within 60 days of delivery hospitalization discharge. >85% of readmissions occurred within the first 30 days of discharge (Figure). 11% (n=28,004) of readmissions were complicated by SMM. Risk for SMM was highest among readmissions occurring 11-20 days after discharge (13.0%, p<0.01) (Table). In adjusted analysis, readmissions <10, 11-20, and 21-30 days after discharge had 6% (RR1.06, 95% CI 1.00, 1.12), 37% (RR=1.37, 95% CI 1.30, 1.45), 20% (RR 1.20, 95% CI 1.13, 1.27) higher risks of SMM than readmissions 51- 60 days after discharge. SMM risk during readmissions 31-40 and 41-50 days after delivery was not significantly different compared to readmissions at 51-60 days. Readmissions in the early postpartum are (i) more likely and (ii) associated with higher risk for SMM. As a result, most readmission morbidity occurs soon after discharge. These findings support that closer interval postpartum follow up may be indicated to diagnosis and reduce risk from conditions that could lead to readmission and associated SMM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)