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A multi-state analysis of postpartum readmissions in the United States
Mark A Clapp1, Sarah E Little1, Jie Zheng2
1Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
Insights
Postpartum readmission rates are rising, with infection, hypertension, and psychiatric illness being key causes. Understanding these trends and risk factors is crucial for improving maternal care quality metrics.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Healthcare Quality Metrics
Background:
- Readmission rates are established quality metrics in many medical fields.
- Data on obstetrics readmissions, specifically postpartum readmissions, are limited.
- This study addresses the gap in understanding postpartum readmission trends and predictors.
Purpose of the Study:
- To analyze trends in postpartum readmissions over time (2004-2011).
- To identify common reasons and associated diagnoses for these readmissions.
- To determine maternal, delivery, and hospital factors associated with increased readmission risk.
Main Methods:
- Utilized State Inpatient Databases from California, Florida, and New York (2004-2011).
- Analyzed data from 5,949,739 deliveries, identifying 114,748 postpartum readmissions within 6 weeks.
- Employed multivariate logistic regression to identify predictors of readmission.
Main Results:
- The postpartum readmission rate increased from 1.72% to 2.16% between 2004 and 2011.
- Common readmission indications included infection (15.5%), hypertension (9.3%), and psychiatric illness (7.7%).
- Maternal comorbidities like psychiatric disease, hypertension, and substance use were significant predictors of readmission.
Conclusions:
- Postpartum readmission rates have shown an upward trend in the United States.
- Identifying risk factors and timing of readmissions is essential for developing targeted interventions.
- This research can inform the creation of new quality metrics for obstetrics care.
Background:
Readmission rates are used as a quality metric in medical and surgical specialties; however, little is known about obstetrics readmissions.
Objective:
Our goals for this study were to describe the trends in postpartum readmissions over time; to characterize the common indications and associated diagnoses for readmissions; and to determine maternal, delivery, and hospital characteristics that may be associated with readmission.
Study Design:
Postpartum readmissions occurring within the first 6 weeks after delivery in California, Florida, and New York were identified between 2004 and 2011 in State Inpatient Databases. Of the 5,949,739 eligible deliveries identified, 114,748 women were readmitted over the 8-year period. We calculated the rates of readmissions and their indications by state and over time. The characteristics of the readmission stay, including day readmitted, length of readmission, and charge for readmission, 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), to be black (18.7% vs 13.5%, P < .001), to have comorbidities such as hypertension (15.3% vs 2.4%, P < 0.001) and diabetes (13.1% vs 6.8%, P < .001), 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%). Patients were readmitted, on average, 7 days after discharge, but readmission day varied by diagnosis: day 3 for hypertension, day 5 for infection, and day 9 for psychiatric disease. Maternal comorbidities were the strongest predictors of postpartum readmissions: psychiatric disease, substance use, seizure disorder, hypertension, and tobacco use.
Conclusion:
Postpartum readmission rates have risen over the last 8 years. 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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