Risk Factors for Postpartum Readmission: An Obstetric Quality Measure [33M

Abstract

INTRODUCTION: The rate of postpartum (PP) readmission reflects both pre-existing and pregnancy-specific morbidities and contributes to the maternal mortality rate. We aimed to investigate the PP readmission rate, associated risk factors, and indicators of healthcare disparities within two hospitals affiliated with our academic institution. METHODS: A retrospective analysis of a prospective, population-based cohort (2011-2019) was performed. Any readmission within 30 days of delivery was included. A random sample of patients with no PP readmission was selected as controls. Characteristics, comorbidities, and labor course were compared. Multivariate logistic regression analyses were performed with appropriate adjustments. RESULTS: Among 42,458 subjects delivered in our affiliated hospitals, 248 (0.6%) had PP readmission. A control group of 1248 was randomly selected in a 5:1 control: case ratio. After controlling for potential confounders identified on univariate analysis, postpartum readmission was more common in women who delivered via cesarean after labor regardless of whether spontaneous or induced (adjusted OR [aOR] 1.38, 95% CI 1.02-1.87). Similarly, pregnancy-related hypertensive disorders or chorioamnionitis increased readmission risk (aOR 1.45, 95% CI 1.04-2.04 and aOR 1.86, 95% CI 1.08-2.04 respectively). Interestingly, among subjects delivered vaginally, induction of labor was associated with a higher risk of PP readmission compared to spontaneous or augmented labor (aOR 2.02, CI 1.37-2.98). CONCLUSION: Pregnancy-related hypertensive disorders, infection, and cesarean delivery are the most significant risk factors associated with PP readmission, as well as induction of labor in those with a vaginal delivery. Current standards of labor-management should continue to consider all factors potentially related to morbidity and mortality.