Postpartum readmissions among women with opioid use disorder

Abstract

Postpartum readmission risk for women with opioid use disorder is not well characterized. The objective of the study was to determine whether opioid use disorder is associated with an increased risk for postpartum readmissions and associated adverse outcomes. The Healthcare Cost and Utilization Project's Nationwide Readmissions Database for 2010-2014 was used to evaluate the risk for postpartum readmission for opioid use disorder within 60 days of discharge from a delivery hospitalization. Opioid use disorder was based on a diagnosis of opioid dependence, abuse, or overdose during the delivery hospitalization. Primary outcomes included 60 day postpartum readmissions for (1) any cause, (2) opioid use disorder, and (3) severe maternal morbidity using Centers for Disease Control and Prevention criteria. We calculated unadjusted riskratios with 95% confidence intervals as measures of effect. Wethen fit log-linear multiple regression analyses to determine adjusted risk ratios with 95% confidence intervals. Demographic, hospital, and obstetric and medical factors were included in the adjusted models. Of 15.7 million deliveries from 2010 to 2014, 67,316 women (0.4%) had a diagnosis of opioid use disorder. Comparing with patients without opioid use disorder, patients with opioid use disorder were more likely to be readmitted for any cause (risk ratio, 2.59, 95% confidence interval, 2.50-2.69) and more likely to be readmitted with severe morbidity (risk ratio, 2.66, 95% confidence interval, 2.42-2.92). Women with opioid use disorder were more likely to be readmitted for drug abuse or overdose (risk ratio, 109.61, 95% confidence interval, 96.22-124.87). These associations retained significance in adjusted models with opioid abuse and dependence associated with increased risk for any-cause readmission (adjusted risk ratio, 2.22, 95% confidence interval, 2.13-2.30), readmission with severe morbidity (adjusted risk ratio, 2.18, 95% confidence interval, 1.98-2.39), and readmission for opioid use disorder (adjusted risk ratio, 67.96, 95% confidence interval, 59.27-77.92). Opioid use disorder is associated with increased risk for postpartum readmission in general and severe morbidity in particular. A large proportion of women at risk for postpartum readmission for opioid and dependence may be identifiable at delivery. Optimization of care for women with these conditions may represent an important component of overall strategies to reduce maternal risk.