384: Maternal age and risk for postpartum readmission and associated morbidity

Abstract

The number of women of advanced maternal age (AMA), defined as age 35 years or greater, is increasing in the United States. While AMA women have increased risks for pregnancy complications from increased underlying comorbidities, little is known regarding specific risk factors for postpartum readmissions and associated complications. We evaluated the risk factors for postpartum readmissions and the associated severe morbidity in this population during their ‘fourth trimester’. Using the Nationwide Readmission Database, the 60-day all-cause postpartum readmission risk from 2010 to 2014 was analyzed. Risk for severe morbidity (SMM) during readmission was ascertained using criteria from the Centers for Disease Control and Prevention. The primary exposure of interest was maternal age (15-18, 19-24, 25- 34, 35-39, 40-44, and >44 years). Outcomes included time to readmission, risk of readmission, and risk for SMM during readmission. Multivariable log linear analyses adjusting for patient, obstetric, and hospital factors were conducted to assess these outcomes using risk ratios (RR) with 95% confidence intervals (CI). Between 2010-2014, we identified 15.3 million deliveries, 15% of which were to women aged 35 or older. The 60-day all-cause readmission rate was 1.8%. Of these, 12% were complicated by SMM. Age-stratification revealed that AMA patients had significantly longer readmission lengths of stay, increased risk for readmission, and increased risk for SMM. The majority of readmissions occurred within the first 20 days regardless of age (Figure 1). In multivariable analysis, AMA patients ages 35-39, 40-44, and >44 years had 11% (RR 1.11, 95% CI 1.09, 1.12), 30% (RR 1.30, 95% CI 1.28, 1.32), and 46% (RR 1.46, 95% CI 1.36, 1.56) significantly higher rates of all-cause readmission when compared to 25-34 year old patients. Women 35-39, 40-44, and >44 years of age had a 19% (95% CI 14-25%), 50% (95% CI 41-59%), and 84% (95% CI 48-131%) higher risk of a readmission with SMM than women 25-34 (Table 1). AMA women are at higher risk for both postpartum readmission and severe morbidity during readmission. Women older than 35 years represent the group most likely to experience complications requiring readmission, with the sharpest risk increase after age 40. For AMA women, particularly those with underlying comorbidities, short-term postpartum follow-up may be indicated to reduce maternal risk.View Large Image Figure ViewerDownload Hi-res image Download (PPT)