706 Severe maternal morbidity and black race increase risk for postpartum readmission

Abstract

Postpartum readmissions may be an indicator of quality of care. Inequities in this metric may suggest unconscious bias by clinicians, or success in a health system by capturing those most at risk. We assessed the association between severe maternal morbidity (SMM) and postpartum readmission by race. We conducted a retrospective cohort study evaluating risk factors for postpartum readmission for all deliveries at the University of Washington Medical Center between 10/1/2013 and 12/31/2019. SMM was determined from pre-specified International Classification of Disease (ICD) codes. All SMM diagnoses were confirmed by chart review. SMM and postpartum readmission rates were calculated using hospital administrative data. Maternal characteristics were compared by readmission status. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated and stratified by race (Black versus non-Black). Of 11,863 deliveries, 111 (1.7%) had a 30-day postpartum readmission and 502 (4.2%) had SMM. Readmission was associated with age, race, multiple gestation, preterm delivery, hypertensive disorders, longer delivery hospitalization, and presence of SMM (Table). Hypertension was the most common reason for readmission (Figure). Black women had a higher odds of hypertension-related readmission compared to non-Black women (70% versus 46%, aOR 4.7, 95% CI 2.0-11.1). Overall, women with any SMM had higher odds of readmission than women without SMM; this finding persisted with adjustment for maternal age and insurance status (aOR 3.5, 95% CI 2.3-5.3). When stratified by race, Black women with SMM had an increased odds of readmission (aOR 6.8, 95% CI 3.1-14.8) compared to non-Black women with SMM (aOR 2.9, 95% CI 1.7-4.9). SMM is a clear risk factor for 30-day postpartum readmission among all women, but especially for Black women. Black women are most likely to be readmitted for hypertension. These findings may help to identify women who are at increased risk for postpartum readmission, which might then lead to preventive strategies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)