873 Risk of unplanned healthcare utilization in postpartum period for women with hypertensive disorders of pregnancy

Abstract

The objective of this study was to determine which factors are associated with unplanned postpartum healthcare utilization, including hospital readmission and unplanned outpatient and emergency room visits, in patients with hypertensive disorders of pregnancy (HDP). This was a case-control study of patients with HDP delivering at a single academic institution from 2014 through 2018. The diagnosis of HDP included chronic hypertension, gestational hypertension, preeclampsia and superimposed preeclampsia. Using univariable and multivariable analysis, demographic and clinical characteristics were compared between patients who had unplanned healthcare utilization, defined as readmission to the hospital, emergency room visit or unplanned outpatient encounter in the first 6 weeks postpartum, and those patients who did not. Of the 1042 patients included in this analysis, 151 (14.5%) had unplanned postpartum healthcare utilization. In multivariable logistic regression, mild range blood pressure on day of discharge after delivery compared with normal range blood pressures (aOR 1.71, 95% CI 1.14-2.58) and HDP with severe features (aOR 3.65, 95% CI 1.64-8.12) were associated with higher odds of unplanned postpartum healthcare utilization. In contrast, chronic hypertension (aOR 0.52, 95% CI 0.31-0.89) and receipt of magnesium sulfate intrapartum or immediately postpartum (aOR 0.22, 95% CI 0.10-0.49) were associated with lower odds of unplanned postpartum healthcare utilization (Table). Among postpartum patients with HDP, severe disease features and mild range blood pressures prior to discharge were associated with higher odds of unplanned healthcare utilization in the first 6 weeks postpartum, while chronic hypertension and receipt of magnesium sulfate were associated with lower odds.