A Multi-State Analysis of Postpartum Readmissions in the United States [26]

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Abstract

INTRODUCTION:

To describe the trends in postpartum readmissions over time, to characterize the common indications for readmissions, and to determine maternal, delivery, and hospital characteristics associated with readmission.

METHODS:

Postpartum readmissions (n=114,748) occurring within the first six weeks after delivery in California, Florida, and New York were identified between 2004–2011 in State Inpatient Databases. We calculated the rates of readmissions and their indications by state and over time. The characteristics of the readmission stay were compared among the diagnoses. Odds ratios were calculated using a multivariate logistic regression to determine the predictors of readmission.

RESULTS:

The readmission rate increased from 1.72% in 2004 to 2.16% in 2011. Readmitted patients were more likely to be publicly insured (54.3% vs 42.0%, P<.001), Black (18.7% vs 13.5%, P<.001), have comorbidities, and to have had a cesarean delivery (37.2% vs 32.9%, P<.001). The most common indications for readmission were infection (15.5%), hypertension (9.3%), and psychiatric illness (7.7%). Readmission day varied by diagnosis: day three for hypertension, day five for infection, and day nine for psychiatric disease. Maternal comorbidities were the strongest predictors of postpartum readmissions: psychiatric disease (OR 2.542 [95% CI 2.448–2.600]), substance use (OR 2.016 [95% CI 1.958–2.075]), seizure disorder (OR 1.989 [95% CI 1.873–2.113]), hypertension (OR 1.886 [95% CI 1.839–1.934]), and tobacco use (OR 1.859 [95% CI 1.800–1.921]).

CONCLUSION/IMPLICATIONS:

Understanding the risk factors, etiologies, and cause-specific timing for postpartum readmissions may aid in the development of new quality metrics in obstetrics and targeted strategies to curb the rising rate of postpartum readmissions in the United States.

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