567 Costs and predictors of early discharge and early readmission risk among national cesarean deliveries

Abstract

In the setting of the COVID-19 pandemic, many obstetrical units performed earlier discharge after cesarean delivery (CD). However, there is little national data regarding utilization of early postpartum discharge (EPD) in the US. The objectives of this study were to analyze the following: (i) predictors of EPD, (ii) risk for early readmission after EPD, and (iii) costs associated with EPD. CD hospitalizations from the 2014-15 Nationwide Readmissions Database were analyzed excluding cases of abnormal placentation, hysterectomy, and severe maternal morbidity. EPD was defined as a postoperative length of stay of ≤2 days and early readmission defined as all cause readmission ≤10 days after discharge was analyzed. Mean delivery and readmission costs were calculated and stratified by EPD. Multivariable log linear analyses were performed to determine factors associated with EPD and to assess the effect of EPD on early readmission risk adjusting for patient, medical, obstetric, and hospital factors. Linear regression models assessed the effect of EPD on mean delivery and readmission hospital costs. We analyzed 1.6 million CD with 534,096 (33.1%) early postpartum discharges. Of the 35,002 postpartum readmissions, 60% (21,125) were within the first 10 days after discharge; EPD had ER rates of 57% versus 61% among routine discharges (p<0.01). EPD was associated with 13% lower risk of overall readmission (aRR=0.87, 95% CI: 0.84, 0.89, p<0.01). Adjusted analysis noted that patients with obstetrical or medical comorbidities were less likely to have EPD (Table 1). In adjusted analyses, EPD was not significantly associated with early readmission (aRR=0.98, 95% CI: 0.95, 1.01, p=0.27). EPD was associated with lower delivery but similar readmission costs with adjusted mean savings of $1,359.61 and $531.98 in the EPD compared to routine discharge groups (p<0.01) (Table 2). EPD is not associated with increased risk of readmission compared to routine discharges. EPD was associated with decreased costs during cesarean delivery hospitalizations.View Large Image Figure ViewerDownload Hi-res image Download (PPT)