546: Early postpartum readmissions or emergency department visits: Identifying risk factors

Abstract

Postpartum readmissions and emergency department visits have emerged as a focus of maternal care quality improvement. Our objective was to investigate factors associated with early readmissions and emergency department visits (RED) after delivery, as these might reflect maternal discharge readiness. We analyzed linked vital statistics and hospital discharge records of California women who gave birth during 2007-2012. We defined RED as a hospital readmission or emergency department visit within 30 days after birth hospitalization. We used multivariable logistic regression to compare women with early RED (0-3 days) or later RED (4-30 days) to women with no RED within 30 days (reference), based on the following factors: medical or obstetric comorbidities or severe maternal morbidity (SMM) at delivery, birth hospitalization length of stay (LOS), cesarean delivery (CD), and birth hospital delivery volume and teaching status. Among 2,843,855 women, 38,154 (1.3%) had early and 100,738 (3.5%) had later RED. After adjustments, we found increased odds of early RED associated with medical (aOR=1.7) and obstetric (aOR=1.7) comorbidities, SMM at delivery (aOR=2.1), extended LOS (aOR=1.4) and CD (aOR=1.6) (Table). Adjusted odds for later RED were similar. High-volume and teaching hospitals cared for patients with higher comorbidity scores (p< 0.01). Compared to delivery at high-volume hospitals, delivery at hospitals with < 500 deliveries/year was associated with increased odds of early (aOR=1.3) as well as later RED (aOR=1.4). Delivery at a teaching hospital was protective of both early and later RED. Women with higher co-morbidity scores, SMM at delivery, longer birth hospital LOS and CD had increased odds for early as well as later RED. Prior to discharge of these patients, there might be opportunities for improved surveillance. Even though higher-volume and teaching hospitals cared for higher-risk women, their early as well as later RED rates were lower. Evaluation of systems of care at larger and teaching hospitals may reveal practices to improve patient discharge readiness.