Predictors and Outcomes of Expedited Postpartum Discharge in a National Sample [ID 2683489

Abstract

INTRODUCTION: Expedited postpartum discharge (EPD), defined as less than 2 days and less than 3 days after vaginal and cesarean birth, respectively, has been postulated as a measure to improve hospital utilization. National trends regarding outcomes after EPD are lacking. This study aims to characterize national trends in EPD, identify predictors, and assess safety using 60-day postpartum readmission as a surrogate marker. METHODS: Birth hospitalizations and readmissions were extracted from the 2016–2020 Nationwide Readmissions Database. Postpartum length of stay (ppLOS) was calculated and categorized as routine, expedited, and prolonged. Annual EPD and readmission prevalence were calculated. Unadjusted and adjusted logistic regression models were fit to assess predictors of EPD and the association between EPD and readmission, adjusting for demographic, clinical, and obstetric outcomes. RESULTS: Of 17.3 million birth hospitalizations, 33% experienced EPD. Expedited postpartum discharge prevalence increased from 29.6% to 44.4% with a higher proportion of EPD in 2020 compared to 2016–2019 (P<.01). Younger and older age, chronic conditions, and obstetric complications were associated with lower likelihood of EPD. The overall 60-day readmission rate after delivery hospitalization discharge was 1.4%, and when stratified by expedited, routine, and prolonged ppLOS were 1.4%, 1.6%, and 3.3%, respectively, with no change in readmission rate during the study period. Hospitalizations with expedited discharge were 14% less likely to be readmitted 60 days after discharge compared to hospitalizations with routine discharge (aOR 0.86; 95% CI: 0.85, 0.88). CONCLUSION: Nationwide rates of EPD increased during the study period with no corresponding increase in 60-day readmission rates, suggesting that EPD may be utilized more widely in appropriate-risk patients.