Risk of unplanned healthcare utilization in postpartum period for patients with hypertensive disorders of pregnancy.

Abstract

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 bivariate and multivariate 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 1427 patients with HDP included in this analysis, 174 (12.2%) had unplanned postpartum healthcare utilization. Maternal non-Hispanic Black race and ethnicity and presence of mild blood pressures on the day of discharge after delivery were associated with higher odds of unplanned healthcare utilization (aOR 1.67, 95% CI 1.08 - 2.56 and aOR 1.59, 95% CI 1.12 - 2.27, respectively). In contrast, presence of chronic hypertension was associated with lower odds of unplanned postpartum healthcare utilization (aOR 0.47, 95% CI 0.28 - 0.79) CONCLUSION: Among postpartum patients with HDP, non-Hispanic Black race and ethnicity and discharge home with mild range blood pressures were associated with higher odds of unplanned healthcare utilization in the first 6weeks postpartum, while chronic hypertension was associated with lower odds.