Risk Of Postpartum Readmission Research Articles

Delivery Outcomes and Postpartum Readmissions Associated with Ehlers-Danlos Syndrome.

Given that updated estimates of Ehlers-Danlos syndrome and risks for obstetric complications including postpartum readmission may be of public health significance, we sought to analyze associated obstetric trends and outcomes in a nationally representative population. The 2016 to 2020 Nationwide Readmissions Database was used for this retrospective cohort study. Delivery hospitalizations to women aged 15 to 54 with and without Ehlers-Danlos syndrome were identified. Temporal trends in Ehlers-Danlos syndrome diagnoses during delivery hospitalizations were analyzed using joinpoint regression to estimate the average annual percent change with 95% confidence intervals (CIs). To determine whether adverse obstetric outcomes during the delivery were associated with Ehlers-Danlos syndrome, unadjusted and adjusted logistic regression models were fit with unadjusted (odds ratio [OR]) and adjusted ORs with 95% CIs as measures of association. In addition to analyzing adverse delivery outcomes, risk for 60-day postpartum readmission was analyzed. An estimated 18,214,542 delivery hospitalizations were included of which 7,378 (4.1 per 10,000) had an associated diagnosis of Ehlers-Danlos syndrome. Ehlers-Danlos syndrome diagnosis increased from 2.7 to 5.2 per 10,000 delivery hospitalization from 2016 to 2020 (average annual percent change increase of 16.1%, 95% CI: 9.4%, 23.1%). Ehlers-Danlos syndrome was associated with increased odds of nontransfusion severe maternal morbidity (OR: 1.84, 95% CI: 1.38, 2.45), cervical insufficiency (OR: 2.14, 95% CI: 1.46, 3.13), postpartum hemorrhage (OR: 1.41, 95% CI: 1.17, 1.68), cesarean delivery (OR: 1.26, 95% CI: 1.17, 1.36), and preterm delivery (OR: 1.35, 95% CI: 1.16, 1.56). Estimates for transfusion, placental abruption, and placenta previa did not differ significantly. Risk for 60-day postpartum readmission was 3.0% among deliveries with Ehlers-Danlos (OR: 1.76, 95% CI: 1.37, 2.25). Ehlers-Danlos syndrome diagnoses approximately doubled over the 5-year study period and was associated with a range of adverse obstetric outcomes and complications during delivery hospitalizations as well as risk for postpartum readmission. · Ehlers-Danlos syndrome diagnoses approximately doubled over the 5-year study period.. · Ehlers-Danlos was associated with a range of adverse obstetric outcomes.. · Ehlers-Danlos was associated with increased readmission risk..

Abstract 001: Hypertensive Disorders Of Pregnancy And Postpartum Readmission

Background: Hypertensive disorders of pregnancy (HDP) are one of the leading causes of maternal death. HDP is a leading cause of postpartum readmissions in the U.S. The initiation of an antihypertensive medication postpartum is at the provider’s discretion with no specific guidelines on when to initiate therapy for mild HDP. Our aim was to identify patients with HDP who were discharged home postpartum without antihypertensive therapy, and to characterize the high-risk patients who required readmission for blood pressure (BP) control. Methods: This was a 2020-2022 single center retrospective study examining readmission rates and characteristics of patients readmitted for HDP complications. Inclusion criteria were age≥18yo, diagnosis of preeclampsia or gestational hypertension, BP prior to discharge at <160/105 mmHg and discharge after delivery with no antihypertensive therapy. Descriptive statistics and bivariate analyses were done as appropriate. Results: A total of 159 patients met all inclusion criteria, with 27 (16.9%) requiring a readmission for hypertension-related reason. There was no difference in sociodemographic characteristics between patients who were readmitted and controls. Patients who were readmitted had a trend toward higher systolic BP at delivery discharge compared to patients who were not readmitted (143mmHg [IQR 136,148] versus 138 [IQR 130,148], p value= 0.09). However, upon readmission, systolic BP was much higher, at median value of 168 mmHg [IQR 149,178]. Among patients who were readmitted, 88.9% were diagnosed with preeclampsia with severe features and 92.6% required magnesium sulfate therapy. Eighty five percent of readmitted patients were started on antihypertensive therapy. Conclusion: Patients with HDP discharged home without antihypertensive medications had 16.9% risk of postpartum readmission. Most of the readmitted patients developed severe HDP features and required outpatient antihypertensive therapy. The results of this study prompt future research to standardize postpartum HDP treatment and identify patients at a high risk for HDP-related complications postpartum.

Predictive Modeling of Hypertension-Related Postpartum Readmission: Retrospective Cohort Analysis.

Hypertension is the most common reason for postpartum hospital readmission. Better prediction of postpartum readmission will improve the health care of patients. These models will allow better use of resources and decrease health care costs. This study aimed to evaluate clinical predictors of postpartum readmission for hypertension using a novel machine learning (ML) model that can effectively predict readmissions and balance treatment costs. We examined whether blood pressure and other measures during labor, not just postpartum measures, would be important predictors of readmission. We conducted a retrospective cohort study from the PeriData website data set from a single midwestern academic center of all women who delivered from 2009 to 2018. This study consists of 2 data sets; 1 spanning the years 2009-2015 and the other spanning the years 2016-2018. A total of 47 clinical and demographic variables were collected including blood pressure measurements during labor and post partum, laboratory values, and medication administration. Hospital readmissions were verified by patient chart review. In total, 32,645 were considered in the study. For our analysis, we trained several cost-sensitive ML models to predict the primary outcome of hypertension-related postpartum readmission within 42 days post partum. Models were evaluated using cross-validation and on independent data sets (models trained on data from 2009 to 2015 were validated on the data from 2016 to 2018). To assess clinical viability, a cost analysis of the models was performed to see how their recommendations could affect treatment costs. Of the 32,645 patients included in the study, 170 were readmitted due to a hypertension-related diagnosis. A cost-sensitive random forest method was found to be the most effective with a balanced accuracy of 76.61% for predicting readmission. Using a feature importance and area under the curve analysis, the most important variables for predicting readmission were blood pressures in labor and 24-48 hours post partum increasing the area under the curve of the model from 0.69 (SD 0.06) to 0.81 (SD 0.06), (P=.05). Cost analysis showed that the resulting model could have reduced associated readmission costs by US $6000 against comparable models with similar F1-score and balanced accuracy. The most effective model was then implemented as a risk calculator that is publicly available. The code for this calculator and the model is also publicly available at a GitHub repository. Blood pressure measurements during labor through 48 hours post partum can be combined with other variables to predict women at risk for postpartum readmission. Using ML techniques in conjunction with these data have the potential to improve health outcomes and reduce associated costs. The use of the calculator can greatly assist clinicians in providing care to patients and improve medical decision-making.

Risk of postpartum readmission: a comparison between stillbirths and live births

Stillbirth is associated with high rates of maternal/obstetric complications and psychiatric impact, which may increase patients’ risk for readmission. This study aimed to examine rate of postpartum readmission after stillbirth (vs. live birth) and associated risk factors and indications.

Critical concept of risk postpartum readmission following postpartum hemorrhage: A multicenter prospective cohort study

Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and morbidity. Therefore, risk factors need to be investigated to control for this serious complication and prevent readmission. The objective of this study is analysis the risk of postpartum readmission for postpartum hemorrhage within sixty days from a delivery hospitalization. Between January 2017 and February 2018, 369 women age 16-45 years enrolled in a prospective cohort study that conducted at Al-Manathera and Al- Zahraa hospitals/ Najaf in Iraq. We evaluated any readmission that occurred within 60 days after delivery hospitalization discharge by Adjusted log linear regression models for only the first readmissions was included in the analysis. A total of 369 patients had a diagnosis of PPH during their delivery in hospital ((214(58%) normal vaginal delivery and 155(42%) caesarian section)); of these 62.4% had isolated PPH, 18.8% had PPH with placenta previa, 12.6% had PPH with hypertention,10.4% had PPH with DIC, 2.6% had a PPH with pregestational DM, and 1.2% had a PPH with gestational DM. Overall 19(7.011) women were readmitted for a primary indication of postpartum hemorrhage. PPH readmissions were most common 1-14 days after discharge (78% of readmissions) and 15-25 days after discharge (13% of readmissions). 5% of readmissions occurred 26-35 days after discharge and 1% occurred 35-60 days after discharge. In conclusion, this data show that the women at high risk of PPH needs close follow up to prevent of readmission for postpartum hemorrhage.

Maternal Health after Stillbirth: Postpartum Hospital Readmission in California.

The aim of this study is to assess whether the risk of postpartum readmission within 6 weeks of giving birth differs for women who had stillbirths compared with live births. Using data from the Office of Statewide Health Planning and Development in California, we performed a population-based cohort study of 7,398,640 births between 1999 and 2011. We identified diagnoses and procedures associated with the first postpartum hospital readmission that occurred within 6 weeks after giving birth. We used log-binomial models to estimate relative risk (RR) of postpartum readmission for women who had stillbirth compared with live birth deliveries, adjusting for maternal demographic, prepregnancy, pregnancy, and delivery characteristics. The rate of postpartum readmission was higher among women who had stillbirths compared with women who had live births (206 and 96 per 10,000 births, respectively). After adjusting for maternal demographic and medical characteristics, the risk of postpartum readmission for women who had stillbirths was nearly 1.5 times greater (adjusted RR = 1.47, 95% confidence interval: 1.35-1.60) compared with live births. Among women with stillbirths, the most common indications at readmission were uterine infection or pelvic inflammatory disease, psychiatric conditions, hypertensive disorder, and urinary tract infection. Based on our findings, women who have stillbirths are at higher risk of postpartum readmissions within 6 weeks of giving birth than women who have live births. Women who have stillbirths may benefit from additional monitoring and counseling after hospital discharge for potential postpartum medical and psychiatric complications. · Women who have stillbirths are at nearly 1.5 times greater risk of postpartum readmission than women who have live births.. · Uterine infections and pelvic inflammatory disease, and psychiatric conditions are the most common reasons for readmission among women who had a stillbirth.. · Women who have stillbirths may benefit from additional monitoring and counseling after hospital discharge for potential postpartum medical and psychiatric complications..

The association between use of opiates, cocaine, and amphetamines during pregnancy and maternal postpartum readmission in the United States: A retrospective analysis of the Nationwide Readmissions Database

BackgroundSubstance use during pregnancy has increased in the United States, with adverse consequences for mother and baby. Similarly, postpartum readmission (PPR) imposes physical, emotional, and financial stressors causing disruption to family functioning and childcare. We used national data to estimate the extent to which women who used opiates, cocaine, and amphetamines during pregnancy are at increased risk of PPR. MethodsWe analyzed 2010–2014 data from the Nationwide Readmissions Database (NRD). Our exposure, drug use during pregnancy, was identified using diagnosis codes indicative of opioid, cocaine or amphetamine use, abuse, or dependence. The outcome was all-cause PPR, maternal readmission within 42 days following discharge from the delivery hospitalization. Multivariable logistic regression was used to estimate odds ratios (OR) that represented associations between drug use and PPR. ResultsAmong 11 million delivery hospitalizations, nearly 1 % had documented use of opiates, cocaine and/or amphetamines. The crude PPR rate was nearly four times higher among users (54.6 per 1000) compared to non-users (14.0 per 1000), and 1 in 10 women who had documented use of more than one drug category experienced postpartum readmission. Even after controlling for sociodemographic and clinical confounders, we observed a two-fold increased odds of PPR among users compared to non-users (OR = 1.95; 95 % CI: 1.82, 2.07). ConclusionsThe national opioid epidemic should encourage a paradigm shift in health care public policy to facilitate the management of all substance use disorders as chronic medical conditions through evidence-based public health initiatives to prevent these disorders, treat them, and promote recovery.

The relationship between severe maternal morbidity and a risk of postpartum readmission among Korean women: a nationwide population-based cohort study

BackgroundAs the rate of cesarean section delivery has increased, the incidence of severe maternal morbidity continues to increase. Severe maternal morbidity is associated with high medical costs, extended length of hospital stay, and long-term rehabilitation. However, there is no evidence whether severe maternal morbidity affects postpartum readmission. Therefore, this study aimed to determine the relationship between severe maternal morbidity and postpartum readmission.MethodsThis nationwide population-based cohort study used the Korean National Health Insurance Service-National Sample cohort of 90,035 delivery cases between January 2003 and November 2013. The outcome variable was postpartum readmission until 6 weeks after the first date of delivery in the hospital. Another variable of interest was the occurrence of severe maternal morbidity, which was determined using the Center for Disease Control and Prevention’s algorithm. The Cox proportional hazard model was used to assess the association between postpartum readmission and severe maternal morbidity after all covariates were adjusted.ResultsThe overall incidence of postpartum readmission was 2041 cases (0.95%) of delivery. Women with severe maternal morbidity had an approximately 2.4 times higher risk of postpartum readmission than those without severe maternal morbidity (hazard ratio 2.36, 95% confidence interval 1.75–3.19). In addition, compared with reference group, women who were aged 20–30 years, nulliparous, and delivered in a tertiary hospital were at high risk of postpartum readmission.ConclusionsSevere maternal morbidity was related to the risk of postpartum readmission. Policy makers should provide a quality indicator of postpartum maternal health care and improve the quality of intrapartum care.

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

Abstract WMP86: Infection During Delivery Hospitalization is Associated With Increased Risk of Readmission for Postpartum Stroke

Introduction: Postpartum stroke is a rare and unpredictable complication of pregnancy. Infections have been associated with an increased risk of stroke in young people. We hypothesized that infections diagnosed during delivery hospitalizations would be associated with an increased risk of postpartum readmission for stroke. Methods: We conducted a weighted analysis of the 2013 Healthcare Cost and Utilization Project National Readmissions Database to assess the relationship between infection during a delivery hospitalization and 30-day readmission for a stroke. Delivery hospitalization, stroke and infections, and comorbidities were identified using ICD-9 diagnosis codes. We created survey design logistic regression models to calculate crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between infections and 30-day readmission for stroke, adjusting for disease severity, length of delivery hospitalization, and age. Results: There were 3,512,350 delivery hospitalizations, with 79,656 subsequent readmissions, including 225 for stroke. Compared with all other women who delivered, women with infections during the delivery hospitalization had higher odds of readmission for postpartum stroke (adjusted OR 5.7, 95%CI 2.4-13.6). When compared to women who were readmitted for non-stroke reasons, women who were readmitted for stroke had higher odds of an infection during the delivery hospitalization (adjusted OR 3.5, 95%CI 1.9-6.5). The effect of infection on postpartum stroke risk was present in women both with and without hypertensive disorders of pregnancy (Table). Conclusion: Infections diagnosed during delivery hospitalizations were associated with an increased risk of readmission for postpartum stroke. Women who are diagnosed with infections during delivery admissions should be educated on signs and symptoms of stroke and when to seek emergency medical attention.

384: Maternal age and risk for postpartum readmission and associated morbidity

The number of women of advanced maternal age (AMA), defined as age 35 years or greater, is increasing in the United States. While AMA women have increased risks for pregnancy complications from increased underlying comorbidities, little is known regarding specific risk factors for postpartum readmissions and associated complications. We evaluated the risk factors for postpartum readmissions and the associated severe morbidity in this population during their ‘fourth trimester’. Using the Nationwide Readmission Database, the 60-day all-cause postpartum readmission risk from 2010 to 2014 was analyzed. Risk for severe morbidity (SMM) during readmission was ascertained using criteria from the Centers for Disease Control and Prevention. The primary exposure of interest was maternal age (15-18, 19-24, 25- 34, 35-39, 40-44, and >44 years). 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 these outcomes using risk ratios (RR) with 95% confidence intervals (CI). Between 2010-2014, we identified 15.3 million deliveries, 15% of which were to women aged 35 or older. The 60-day all-cause readmission rate was 1.8%. Of these, 12% were complicated by SMM. Age-stratification revealed that AMA patients had significantly longer readmission lengths of stay, increased risk for readmission, and increased risk for SMM. The majority of readmissions occurred within the first 20 days regardless of age (Figure 1). In multivariable analysis, AMA patients ages 35-39, 40-44, and >44 years had 11% (RR 1.11, 95% CI 1.09, 1.12), 30% (RR 1.30, 95% CI 1.28, 1.32), and 46% (RR 1.46, 95% CI 1.36, 1.56) significantly higher rates of all-cause readmission when compared to 25-34 year old patients. Women 35-39, 40-44, and >44 years of age had a 19% (95% CI 14-25%), 50% (95% CI 41-59%), and 84% (95% CI 48-131%) higher risk of a readmission with SMM than women 25-34 (Table 1). 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 sharpest risk increase after age 40. For AMA women, particularly those with underlying comorbidities, short-term postpartum follow-up may be indicated to reduce maternal risk.View Large Image Figure ViewerDownload Hi-res image Download (PPT)