766 Risk of antepartum readmission among pregnant women hospitalized for opiate use disorder

Abstract

Patients with opiate use disorder are more likely to be readmitted within 30 and 90 days following a hospitalization compared to non-substance using patients, with readmission rates estimated between 12-18%. However, hospitalizations and the reasons for readmissions among pregnant women with opiate use disorder have not been characterized. Thus, the objective of this study was to assess for the risk of readmission following a hospitalization for opioid treatment initiation among pregnant women with opiate use disorder. This was a retrospective study of 157 pregnant women hospitalized for opiate use disorder from May 2011 to November 2018 at a tertiary care academic medical center in Pittsburgh, Pennsylvania. Demographics and clinical characteristics, including readmission rates and indications were extracted from the medical record. There were 157 women included in our analysis across 170 pregnancy episodes. The initial hospitalization for all of the participants was for conversion to opioid pharmacotherapy with either methadone or buprenorphine. Following this hospitalization, the antepartum readmission rate was 23.5% (40/170). Of these 40, 35 (87.5%) readmissions were for opioid agonist re-conversion or titration, and 5 (12.5%) were for other medical indications. There were 20 patients with 1 readmission and 8 patients with multiple readmissions (mean 2.5; standard deviation 0.5) during their pregnancy. In our cohort of 157 pregnant women with opiate use disorder, there was a higher (23.5%) risk of antepartum readmission following their initial hospitalization for medication initiation. The majority of readmissions were related to resumption of illicit drug use and the need for repeated initiation of opioid pharmacotherapy, demonstrating a critical gap in treatment adherence for this population. Additional research focused on the patient-level characteristics predictive of the need for recurrent hospitalization for opioid use disorder during pregnancy is warranted.