Postpartum Readmission Research Articles

1095: Postpartum readmissions among women with adult congenital heart disease

1095: Postpartum readmissions among women with adult congenital heart disease

546: Early postpartum readmissions or emergency department visits: Identifying risk factors

Postpartum readmissions and emergency department visits have emerged as a focus of maternal care quality improvement. Our objective was to investigate factors associated with early readmissions and emergency department visits (RED) after delivery, as these might reflect maternal discharge readiness. We analyzed linked vital statistics and hospital discharge records of California women who gave birth during 2007-2012. We defined RED as a hospital readmission or emergency department visit within 30 days after birth hospitalization. We used multivariable logistic regression to compare women with early RED (0-3 days) or later RED (4-30 days) to women with no RED within 30 days (reference), based on the following factors: medical or obstetric comorbidities or severe maternal morbidity (SMM) at delivery, birth hospitalization length of stay (LOS), cesarean delivery (CD), and birth hospital delivery volume and teaching status. Among 2,843,855 women, 38,154 (1.3%) had early and 100,738 (3.5%) had later RED. After adjustments, we found increased odds of early RED associated with medical (aOR=1.7) and obstetric (aOR=1.7) comorbidities, SMM at delivery (aOR=2.1), extended LOS (aOR=1.4) and CD (aOR=1.6) (Table). Adjusted odds for later RED were similar. High-volume and teaching hospitals cared for patients with higher comorbidity scores (p< 0.01). Compared to delivery at high-volume hospitals, delivery at hospitals with < 500 deliveries/year was associated with increased odds of early (aOR=1.3) as well as later RED (aOR=1.4). Delivery at a teaching hospital was protective of both early and later RED. Women with higher co-morbidity scores, SMM at delivery, longer birth hospital LOS and CD had increased odds for early as well as later RED. Prior to discharge of these patients, there might be opportunities for improved surveillance. Even though higher-volume and teaching hospitals cared for higher-risk women, their early as well as later RED rates were lower. Evaluation of systems of care at larger and teaching hospitals may reveal practices to improve patient discharge readiness.

494: Risk of postpartum readmission and severe maternal morbidity in women with pre-gestational diabetes

494: Risk of postpartum readmission and severe maternal morbidity in women with pre-gestational diabetes

245: Maternal genitourinary and wound infections: Early postpartum readmissions and emergency department visits

245: Maternal genitourinary and wound infections: Early postpartum readmissions and emergency department visits

155: Hospital admissions 2 to 9 months after delivery among women with adult congenital heart disease

Women with adult congenital heart disease (ACHD) are at increased risk of postpartum readmissions. However, longer term risk for hospitalizations is not well characterized. This analysis sought to characterize risk for hospital admissions 2 to 9 months after delivery hospitalization for women with ACHD. Delivery hospitalizations for women with ACHD (categorized into complex, non-complex, and unspecified ACHD) were abstracted from the 2010-2014 Nationwide Readmissions Database with follow up through 9 months after delivery hospitalization discharge. Multivariable log linear regression models were fit for the outcome of readmission from 2 to 9 months following delivery adjusting for type of ACHD, patient, obstetric, and other underlying cardiac factors. We identified 3,507 deliver hospitalizations occurring between January-March of 2010-2014 with an all-cause hospitalization rate of 7.9% in the first 9 months after delivery. 44% of readmissions occurred within 60 days after delivery hospitalization discharge with the majority (56%) occurring 2 to 9 months after discharge (Figure 1). The median time to readmission was 72 days. Among readmissions from 2 to 9 months after discharge, patients with complex ACHD were at 64% higher risk of readmission (RR 1.64, 95% CI 1.01, 2.67) while factors like congestive heart failure, arrhythmias, and obstetrical factors were not associated with elevated risk (Table 1). The majority of ACHD hospitalizations in the 9 months after delivery occur after 2 months postpartum. These findings support the importance of health care coverage and continuity for this high-risk population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

103: Predictive modeling of postpartum readmission for hypertension: A retrospective study

103: Predictive modeling of postpartum readmission for hypertension: A retrospective study

301: Postpartum readmissions for cardiac indications among women without a history of cardiac disease

To determine risk of postpartum readmissions for cardiac indications among women without a history of cardiac disease. Delivery hospitalizations with no cardiac diagnoses were identified from the 2010-2014 Nationwide Readmissions Database and linked with subsequent cardiac hospitalizations over the following 9 months. Cardiac readmissions were defined as readmissions with cardiac interventions or diagnoses including cardiomyopathy or heart failure. Temporality of new onset cardiac hospitalizations was calculated for each 30-day interval from delivery discharge up to 9 months postpartum. Multivariable log linear regression models were fit to identify risk factors for cardiac readmissions adjusting for patient, medical, obstetrical, and hospital factors. A sensitivity analysis was repeated restricted to readmissions where cardiac causes were the primary indication for readmission. Of 4.5 million deliveries, the readmission rate for new onset cardiac condition was 27 per 10,000 low risk deliveries. 56.2% occurred within the first 60 days with persistence in the extended postpartum period (Figure 1). Factors such as lupus (RR 4.52, 95% CI: 3.73-5.46), hypertensive diseases of pregnancy (RR 2.17, 95% CI: 2.07-2.27), thromboembolism (RR 3.05, 95% CI: 2.27-4.08), or severe maternal morbidity at delivery (RR 2.30, 95% CI: 2.05-2.57) were associated with significantly increased risks of cardiac readmission (Table 1). Similar results were noted in our sensitivity analyses. Among low risk patients, multiple medical factors and obstetrical complications are associated with development of new cardiac disease requiring readmission in the postpartum period. These patients may benefit from improved surveillance in the early postpartum period.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Postpartum Readmissions Among Women With Diabetes.

To estimate whether women with diabetes are at risk for 60-day postpartum readmissions and associated complications. The Nationwide Readmissions Database from 2010 to 2014 was analyzed to determine risk for 60-day postpartum readmissions among women with type 1 diabetes mellitus (DM), type 2 DM, gestational diabetes mellitus (GDM), and unspecified DM compared with women with no diabetes. Secondary outcomes included evaluating risk for overall severe maternal morbidity during readmissions, as well as wound complications, acute diabetic complications such as diabetic ketoacidosis, venous thromboembolism, and hypertensive diseases of pregnancy. Billing data were used to ascertain both exposures and outcomes. Adjusted log-linear regression models including demographic, hospital, medical and obstetric, and hospital factors were performed with adjusted risk ratios (aRRs) and with 95% Cis as measures of association. Of an estimated 15.7 million delivery hospitalizations, 1.1 million occurred among women with diabetes, of whom 3.2% had type 1 DM, 9.1% type 2 DM, 86.6% GDM, and 1.1% unspecified diabetes. Compared with women without diabetes (1.5% risk for readmission), risk for readmission was significantly higher for women with type 1 DM (4.4%), unspecified diabetes (4.0%), type 2 DM (3.9%), and GDM (2.0%) (P<.01). After adjusting for hospital, demographic, medical, and obstetric risk factors, type 1 DM (aRR 1.77, 95% CI 1.69-1.87), type 2 DM (aRR 1.46, 95% CI 1.42-1.51), unspecified (aRR 1.73, 95% CI 1.59-1.89) and gestational diabetes (aRR 1.16, 95% CI 1.14-1.17) retained increased risk. Among women with diabetes public insurance, lower ZIP code income quartiles, and hospitals with high safety net burdens were associated with higher risk for readmission. In both unadjusted and adjusted analyses, all diabetes diagnoses were associated with readmissions for wound complications, hypertensive diseases of pregnancy, and severe maternal morbidity. Although overall risk for readmission is low, pregnancies complicated by pregestational diabetes in particular are at increased risk. Women in this high-risk group should receive coordinated care and be monitored closely in the postpartum period.

Institutional prevalence of class III obesity modifies risk of adverse obstetrical outcomes

Women with prepregnancy class III obesity (body mass index ≥40 kg/m2) are at an increased risk of perinatal complications and adverse obstetrical outcomes. Estimates of the magnitude of risk that these women face vary widely, which may reflect differences in institutional experience caring for women with obesity. We sought to characterize the relationship between institutional prevalence of prepregnancy class III obesity and the risk of adverse perinatal outcomes among these women, hypothesizing that higher-prevalence institutions would have lower rates of adverse maternal and perinatal outcomes among this population. We conducted a retrospective cohort study using chart-abstracted data on births in Washington state from Jan. 1, 2012, to Dec. 31, 2017. The analysis was restricted to hospitals that delivered at least 1 patient per month with prepregnancy class III obesity. Institutional prevalence of prepregnancy class III obesity was calculated, and hospitals were classified as either high or low prevalence. We included nulliparous women with vertex-presenting singleton pregnancies at ≥37 weeks of gestation. We excluded births with missing initial body mass index. The primary outcome was the incidence of cesarean delivery. Secondary outcomes were induction of labor, postpartum complications, postpartum readmission, and neonatal intensive care unit admissions. We compared outcomes between women with prepregnancy class III and all obesity at high- and low-prevalence hospitals using the χ2 test or the Fishers exact test as appropriate. Binary logistic regression was performed to compare outcomes at high- and low-prevalence hospitals. A hospital-adjusted multivariable regression model that controlled for baseline institutional rates of each outcome and compared outcomes between high- and low-prevalence hospitals was developed. A final multivariable logistic regression that controlled for both baseline institutional variation as well as potential clinical confounders was performed. A total of 20,556 women at 6 hospitals were eligible for inclusion; the prevalence of prepregnancy class III obesity was 6.2% and 2.1% in high- and low-prevalence hospitals, respectively. Obese women, including those with class III obesity in a high-prevalence hospital, were more likely to be Latina and less likely to be of advanced maternal age and carry private insurance. After adjusting for the institutional cesarean delivery rate, women with prepregnancy class III obesity had significantly increased odds of cesarean delivery (odds ratio, 1.53, 95% confidence interval, 1.12-2.10); however, after adjusting for significant covariates, the association no longer achieved significance (odds ratio, 1.68, 95% confidence interval, 0.97-2.94). The hospital-adjusted odds of postpartum readmission were significantly increased for women with prepregnancy class III obesity when delivering in low-prevalence institutions (odds ratio, 6.61, 95% confidence interval, 1.93-22.56), and the association was further strengthened after controlling for significant covariates (odds ratio, 15.20, 95% confidence interval, 2.32-99.53). None of the models demonstrated significantly different odds of induction of labor, postpartum complications, or neonatal intensive care unit admission by institutional prevalence of prepregnancy class III obesity. Even after controlling for underlying hospital andsubject characteristics, women with prepregnancy class III obesity had significantly increased odds of postpartum readmission, and a trend toward increased odds of cesarean delivery, when delivering in institutions with less experience caring for women with obesity.

Inpatient mortality and postpartum readmission rates in sickle cell disease pregnancies: a multistate analysis, 2007–2014

Objective We compared post-partum outcomes between sickle cell disease (SCD) and non-sickle cell populations. Methods We conducted a retrospective analysis of discharge data for 6,911,916 inpatient deliveries in the states of California, Florida, New York, Maryland, and Kentucky from 2007 to 2014 using data from the State Inpatient Databases, Healthcare Cost and Utilization Project. We compared unadjusted rates and adjusted odds of 30- and 90-d readmission rates, in-hospital mortality, length of stay (LOS), and total hospital charges in SCD, sickle cell trait, and non-sickle cell patients. Results Compared to non-sickle cell patients, SCD patients were more than two times as likely to die in-hospital (aOR: 2.16, 95% CI: 1.15–4.04, p < .05), 27% as likely to be readmitted up to 30 d postdelivery (aOR: 1.27, 95% CI: 1.13–1.43, p < .001), and 92% as likely to be readmitted up to 90 d postdelivery (aOR 1.92, 95% CI: 1.75–2.11, p < .001). The SCD group also had a longer median LOS, greater total hospital charges, were more likely to experience a postpartum complication, and receive a blood transfusion than the non-SCD group. Conclusions SCD in pregnancy is associated with increased inpatient mortality, readmissions, postpartum complications, LOS, and hospital charges.

Rate and causes of severe maternal morbidity at readmission: California births in 2008-2012.

To determine the rate, maternal characteristics, timing, and indicators of severe maternal morbidity (SMM) that occurs at postpartum readmission. Women with a birth in California during 2008-2012 were included in the analysis. Readmissions up to 42 days after delivery were investigated. SMM was defined as presence of any of the 21 indicators defined by ICD-9 codes. Among 2,413,943 women with a birth, SMM at readmission occurred in 4229 women. Of all SMM, 12.1% occurred at readmission. Over half (53.5%) of the readmissions with SMM occurred within the first week after delivery hospitalization. The most common indicators of SMM were blood transfusion, sepsis, and pulmonary edema/acute heart failure. Twelve percent of SMM was identified at readmission with the majority occurring within 1 week after discharge from delivery hospitalization. Because early readmission may reflect lack of discharge readiness, there may be opportunities to improve care.

Opioid Use Disorder during Antepartum and Postpartum Hospitalizations.

This study aimed to evaluate temporal trends in opioid use disorder (OUD) during antepartum and postpartum hospitalizations. This repeated cross-sectional analysis analyzed data from the National (Nationwide) Inpatient Sample. Women aged 15 to 54 years admitted antepartum or postpartum were identified. The presence of OUD was determined based on a diagnosis of opioid abuse, opioid dependence, or opioid overdose. Temporal trends in OUD were evaluated using the Rao-Scott chi-square test. Temporal trends in opioid overdose were additionally evaluated. An estimated 7,336,562 antepartum hospitalizations and 1,063,845 postpartum readmissions were included in this analysis. The presence of an OUD diagnosis during antepartum hospitalizations increased from 0.7% of patients in 1998 to 1999 to 2.9% in 2014 (p < 0.01) and during postpartum hospitalizations increased from 0.8% of patients in 1998 to 1999 to 2.1% of patients in 2014 (p < 0.01). Risk of overdose diagnoses increased significantly for both antepartum hospitalizations, from 22.7 per 100,000 hospitalizations in 1998 to 2000 to 70.3 per 100,000 hospitalizations in 2013 to 2014 (p < 0.001), and postpartum hospitalizations, from 18.8 per 100,000 hospitalizations in 1998 to 2000 to 65.2 per 100,000 hospitalizations in 2013 to 2014 (p = 0.02). Risk of OUD diagnoses and overdoses increased over the study period for both antepartum and postpartum hospitalizations.

Infection During Delivery Hospitalization and Risk of Readmission for Postpartum Stroke.

Background and Purpose- Most cases of pregnancy-related ischemic stroke (IS) and hemorrhagic stroke (HS) occur postpartum. Infections have been identified as a trigger for strokes in young people and have been associated with strokes during delivery hospitalizations, but a temporal relationship has been difficult to establish. We hypothesized that infections diagnosed during a delivery admission would be associated with an increased risk of readmission for postpartum stroke. Methods- We conducted a retrospective cohort study using the Healthcare Cost and Utilization Project's National Readmissions Database from 2010 to 2014. Using weighted survey design Poisson regression analysis, we calculated adjusted risk ratios (aRR) and 95% CI for the association between infection during delivery admission and 30-day postpartum readmission for IS or HS. Results- Out of 17.2 million delivery admissions during the study period, 2128 were readmitted within 30 days for a stroke of any type. There were 1189 HS (intracerebral hemorrhage or subarachnoid hemorrhage) and 720 IS, and the remainder unspecified pregnancy-related stroke. Adjusting for age and comorbidities, women with delivery infections were at higher risk of readmission for postpartum stroke of any type (aRR, 1.19; 95% CI, 1.01-1.41). Women with infections had higher risk of readmission for postpartum IS (aRR, 1.75; 95% CI, 1.37-2.22), but not for postpartum HS (aRR, 0.96; 95% CI, 0.75-1.23). The effect of infection on 30-day IS readmission was larger in women without hypertensive disorders of pregnancy (aRR, 2.0; 95% CI, 1.55-2.69 in women without hypertensive disorders of pregnancy versus aRR, 1.47; 95% CI, 0.9-2.38 in women with hypertensive disorders of pregnancy, P value for interaction=0.09). Conclusions- Infection during delivery hospitalization was associated with increased risk of readmission for IS, but not HS, within 30 days postpartum, particularly in women without hypertensive disorders of pregnancy. Infection may play a role in triggering postpartum IS even in the absence of other risk factors.

Patient and hospital characteristics associated with severe maternal morbidity among postpartum readmissions

To examine the influence of socioeconomic, clinical, and hospital characteristics on the risk of severe maternal morbidity among postpartum readmissions. A cross-sectional analysis was conducted using the National Inpatient Sample 2006-2012 to estimate the risk of severe maternal morbidity and identify potential risk factors. Odds ratios were calculated using multivariate logistic regression. Women aged ≥35 years (ages 35-39: OR 1.12 [CI 1.06, 1.19]; ages 40+: OR 1.27 [CI 1.17, 1.39]), non-Hispanic blacks (OR 1.16 [CI1.10, 1.22]), and women with pre-existing medical conditions (OR 1.62 [CI 1.56, 1.68]) were at greater risk of severe maternal morbidity during postpartum readmissions. Women hospitalized outside the Northeast region (Midwest: OR 1.20 [CI 1.10, 1.30]; South: OR 1.29 [CI 1.20, 1.38]; West: OR 1.33 [CI1.22, 1.44]) were also at increased risk. The risk of severe maternal morbidity is heightened beyond delivery hospitalization for a subset of high-risk women.

Reduction of hospital stay at maternity unit: an evaluation of the impact on maternal and neonatal readmission

In June 2015, the Belgian federal minister of public health imposed a reduction of 1 day in hospital stay at the maternity unit. This retrospective cohort study evaluated data of all patients who delivered between January 01 2010 and November 30 2015. Neonatal readmissions during the first 28 days postpartum and maternal readmissions during the first 6 weeks postpartum were studied. In total, 6009 births were included. The neonatal readmissions significantly increased (4.8% versus 6.9%, p value = .04) after June 2015. There was no significant difference in maternal readmissions between groups. In conclusion, hospital stay reduction at the maternity unit was linked with an increase of neonatal readmissions in the first 28 days postpartum, but did not have an effect on the maternal readmissions.Impact StatementWhat is already known on this subject? Many studies have evaluated the impact of early discharge on maternal and neonatal morbidity since 1950. Nevertheless, there are still concerns regarding the advantages and inconveniences of this policy. This retrospective cohort study took place in a tertiary referral centre in Belgium (CHU Tivoli) and evaluated data of all patients who delivered between January 01 2010 and November 30 2015.What the results of this study add? The readmissions for icterus increased significantly after the introduction of the reduced stay. There was no significant difference in maternal readmissions between groups.What the implications are of these findings for clinical practice and/or further research? A shorter hospital may be linked with an increase of neonatal readmissions in the first 28 days postpartum, but does not seem to have an effect on the maternal readmissions. Further prospective studies are needed in order to validate this hypothesis and also elucidate the reasons leading to a higher neonatal readmission rate.

Risk for postpartum readmissions and associated complications based on maternal age

Purpose To evaluate risk for postpartum readmissions and associated severe morbidity by maternal age. Materials and Methods This retrospective cohort study used the Nationwide Readmissions Database to analyze 60-day all-cause postpartum readmission risk from 2010 to 2014. Risk for severe maternal morbidity (SMM) during readmission was ascertained using criteria from the Centers for Disease Control and Prevention. The primary exposure of interest was maternal age. Outcomes included time to readmission, risk of readmission, and risk for SMM during readmission. Multivariable log linear analyses adjusting for patient, obstetric, and hospital factors were conducted to assess readmission and SMM risk with adjusted risk ratios (aRRs) with 95% confidence intervals (CIs) as measures of effect. Results Between 2010 and 2014, we identified 15.7 million deliveries, 15% of which were to women aged 35 or older. The 60-day all-cause readmission rate was 1.7%. Of these, 13% were complicated by SMM. Age-stratification revealed that women 35 and older were at increased risk for readmission and increased risk for SMM. The majority of readmissions occurred within the first 20 days regardless of age; although, women 35 and older were more likely to be admitted within the first 10 days of discharge. Patients ages 35–39, 40–44, and >44 years had 9% (95% CI 7–10%), 37% (95% CI 34–39%), and 66% (95% CI 55–79%) significantly higher rates of postpartum readmission when compared to women age 25–29. Women 35–39, 40–44, and >44 years of age had a 15% (95% CI 10–21%), 26% (95% CI 18–34%), and 56% (95% CI 25–94%) higher risk of a readmission with SMM than women 25–29. Conclusions AMA women are at higher risk for both postpartum readmission and severe morbidity during readmission. Women older than 35 years represent the group most likely to experience complications requiring readmission, with the highest risk age 40 and older.

Are Longer Periods of Latency After the Diagnosis of Preeclampsia Associated With Readmission? [31G

INTRODUCTION: To determine if longer periods of latency after the diagnosis of preeclampsia with severe features is associated with postpartum readmission or complications. METHODS: This was a nested case control study of all patients with severe preeclampsia at an academic medical center from 2014 until 2017. The primary outcome was readmission within six weeks of discharge. The primary exposure was pregnancy latency after the diagnosis of preeclampsia with severe features until delivery. Secondary exposures were the differing severe features or complications of preeclampsia which the patients were diagnosed with during their antepartum admission. Controls were randomly selected from the patients who had been diagnosed with preeclampsia with severe features in a 2:1 ratio. Median latency, baseline characteristics, severe features, and complications of preeclampsia were compared between patients who were readmitted and those who were not. RESULTS: Of the 18,645 deliveries over this time period, 950 were complicated by preeclampsia with severe features. Of these deliveries, 39 were readmitted. The median gestational age on admission was 37 weeks and one day. Contrary to our hypothesis, readmission was more likely with shorter latencies (mean rank 65 vs 45, p<0.01). Pregestational diabetes was a risk factor for readmission (OR 3.2, p=0.04); Antepartum headache (OR 0.36, p=0.02), parenteral antihypertensives (OR .30, p<0.01), oral antihypertensives (OR 0.25, p<0.01), antepartum magnesium sulfate (OR 0.07, p<0.01) during the initial admission were protective. CONCLUSION: Analyzing the factors that contribute to readmission in preeclamptic patients allow us to be cognizant of factors that may lead to increased maternal morbidity and mortality.

Postpartum hemorrhage and risk for postpartum readmission

Objective: This study had two objectives: (i) to evaluate risk factors for postpartum readmission for a primary diagnosis of postpartum hemorrhage (PPH) among all women, and (ii) to determine risk for postpartum readmission specifically among women with PPH during their delivery hospitalization. Methods: The Healthcare Cost and Utilization Project’s Nationwide Readmissions Database for 2010 to 2014 was used to evaluate risk for postpartum readmission for PPH within 60 days of discharge from a delivery hospitalization. Obstetric, medical, demographic, and hospital factors including PPH during the index delivery were analyzed. Sixty-day postpartum readmission for PPH was the primary outcome. Both unadjusted and adjusted analyses were performed. In adjusted models, the risk was characterized as adjusted risk ratios (aRR) with 95% confidence intervals (CI). As a secondary outcome to further characterize how PPH at delivery was associated with readmission likelihood, the risk for all-cause readmission was evaluated among women with this diagnosis during their delivery. Results: Of the 15,701,150 delivery hospitalizations, 10,618 women were readmitted postpartum for a primary indication of postpartum hemorrhage. Eighty-two percent of readmissions occurred ≤20 days after discharge. In the adjusted model for readmission for PPH, PPH during the delivery hospitalization was associated with aRR of 5.26 (95% CI 4.94, 5.59) for hemorrhage alone, aRR of 14.28 (95% CI 13.06, 15.60) for hemorrhage requiring transfusion, and aRR of 12.40 for PPH with disseminated intravascular coagulation (DIC) requiring transfusion (95% CI 9.56–16.08) compared to no PPH. For the secondary analysis evaluating all-cause readmission, PPH during delivery was associated with aRR of 1.47 for PPH alone (95% CI 1.44–1.51), aRR of 2.43 for PPH requiring transfusion (95% CI 2.34–2.52), and aRR of 2.77 for PPH with DIC requiring transfusion (95% CI 2.54–3.03) compared to no PPH. Conclusion: PPH at delivery is a significant risk factor for subsequent readmission both for PPH and for all causes. For women who undergo large hemorrhage during delivery, shorter interval postpartum follow-up may be indicated.

Hypertensive Postpartum Admissions Among Women Without a History of Hypertension or Preeclampsia.

To analyze risk factors, temporality, and outcomes for women readmitted postpartum for a hypertensive indication who did not have a hypertensive diagnosis during their delivery hospitalization. The Healthcare Cost and Utilization Project's Nationwide Readmissions Database for 2010-2014 was used to evaluate risk for postpartum readmission for preeclampsia and hypertension within 60 days of discharge from a delivery hospitalization among women without these diagnoses during delivery in this cohort study. Obstetric, medical, demographic, and hospital factors associated with postpartum readmission were analyzed. Both unadjusted and adjusted analyses were performed. Risk was characterized as unadjusted and adjusted risk ratio with 95% CI. As a secondary outcome, risk for severe maternal morbidity during readmissions was also evaluated comparing women with and without hypertensive diagnoses during their delivery hospitalization. Among delivery hospitalizations without a hypertensive diagnosis at delivery, absolute rates of readmission within 60 days for a hypertensive indication were low, with one readmission occurring per 687 deliveries for all women. The rate rose to 1 in 498 among women 35-39 years of age, 1 in 337 for women 40-54, 1 in 601 for women with Medicaid, 1 in 506 for women with Medicare, 1 in 497 with cesarean delivery, 1 in 600 with postpartum hemorrhage, 1 in 455 and 1 in 378 for gestational and pregestational diabetes, respectively, 1 in 428 for asthma, 1 in 225 for chronic kidney disease, and 1 in 214 for lupus. For the secondary outcome, risk for severe maternal morbidity was higher for women without a hypertensive indication during their delivery compared with women with a diagnosis (12.1% vs 6.9%, P<.01). Risk for hypertensive postpartum readmissions for women without delivery-hospitalization preeclampsia or hypertension is low. Future comparative effectiveness and clinical research is indicated to determine whether earlier postpartum identification of elevated blood pressure followed by increased surveillance and counseling may further reduce risk.

Socioeconomic, Racial, and Ethnic Disparities in Postpartum Readmissions in Patients with Preeclampsia: a Multi-state Analysis, 2007-2014.

Childbirth is the most common reason for hospitalization for reproductive-aged women, with about 4 million annual deliveries nationally. Hypertension is the leading indication for postpartum readmission and therefore women with preeclampsia are at high risk for readmission. Social determinants of health are associated with increased readmission in postpartum patients; however, no study has specifically investigated readmissions in this higher risk group of patients. We sought to evaluate the effect of social determinants of health on postpartum readmissions in all postpartum patients and in a subgroup analysis of those with a diagnosis of preeclampsia. We conducted a retrospective (2007-2014) analysis of all singleton deliveries in Florida, California, New York, and Maryland from the State Inpatient Databases, Healthcare Cost and Utilization Project. Primary outcomes were readmission at 30days after delivery. Descriptive statistics were calculated, and multivariate regression analysis was used to estimate the adjusted odds ratio (OR) for readmissions. Subgroup analysis was performed on preeclampsia patients only. Statistical significance was evaluated at the < 0.05 alpha level. A total of 4,999,993 patients were included in our analysis. Among all postpartum patients and in subgroup analysis for preeclampsia patients only, readmission rates are higher for black patients, patients in the poorest quartile of median income, and patients with public insurance (Medicare or Medicaid). The present study has shown that socioeconomic and racial/ethnic disparities exist in postpartum readmissions. These findings additionally exist among the already highest-risk preeclamptic patients. Future research should further elucidate this relationship and develop amelioration strategies.