860 Risk assessment tool for postpartum readmission due to De-Novo or progressive pregnancy-associated hypertensive disease

Abstract

Postpartum readmission for hypertension is the 2nd most common indication for readmission in the postpartum period. We sought to create a model that quantifies an individual’s risk for postpartum readmission due to hypertension. This was a retrospective cohort study of all women who delivered at MedStar Washington Hospital Center (Washington, DC) from January 2009 through June 2018. Postpartum readmission due to hypertension was defined as readmission due to severe hypertension in the postpartum period (>48 hours to 6 weeks). A univariable regression model was used to compare maternal demographics, labor and delivery outcomes, and postpartum systolic blood pressure between women that were readmitted due to hypertension and women that were not. Variables with P-value <.05 were considered for the mixed multivariable logistic regression model in a backward stepwise fashion. Receiver operating characteristic (ROC) curves with the area under a curve (AUC) were created to assess prediction of postpartum readmission due to hypertension. Internal validation was conducted using 500 bootstrap resamples to obtain an optimism-corrected AUC estimate. Youden’s test was used to obtain the optimal cutoff point from the ROC analysis. Of 32,162 women that delivered, 182 (0.57%) had postpartum readmissions due to hypertension. Maternal factors predictive of readmission (P-value <.05) included hypertension, cesarean delivery, African-American race, older maternal age, multiple gestation, a higher day 1 systolic blood pressure, and an increase in systolic blood pressure from day 1 to day 2 (Table 1). The patient’s values are entered into the tool and a probability of readmission due to hypertension is calculated. The predictive model was found to have an AUC of 0.80 (0.78-0.84) with a sensitivity of 77.1% specificity of 75.2% using a predicted probability of 0.6% as cutoff point (Image 1). Accurate identification of high-risk women may provide clinicians with opportunities to provide specified education, encourage earlier postpartum follow up and monitor blood pressures at home.View Large Image Figure ViewerDownload Hi-res image Download (PPT)