Impact of substance use and trauma on postpartum readmission rates and hospitalization costs: An observational study

Substance use disorder (SUD) has been seen to be a contributing factor in the rise in maternal morbidity and mortality in the United States, and more information is needed regarding the impact of SUD on peripartum outcomes. We hypothesized that patients with an SUD diagnosis at the time of delivery would have higher rates of readmission compared with patients without an SUD diagnosis. In addition, we assessed the impact of a trauma-/stress-related diagnosis, both alone and when cooccurring with SUD, at the time of delivery on readmission and healthcare utilization, given the high comorbidity of SUD and trauma.

National Readmission Database data from 2016 to 2019 were collected to estimate hospital cost and readmission rates in the United States. The primary outcome measure was hospital readmission within 42 days of delivery. Healthcare utilization costs (i.e. delivery cost, readmission cost, and total cost) were also examined. Logistic regressions and linear models were used to assess differences between patients with and without SUD and trauma diagnoses.

Data from 6 445 496 delivery hospitalizations were used. Patients with an SUD diagnosis had 28% higher odds of readmission compared with those without an SUD diagnosis (adjusted odds ratio, 1.28; P < 0.001), while patients with a trauma-/stress-related diagnosis were shown to have a 34% higher odds of readmission compared with those without these diagnoses (adjusted odds ratio, 1.34; P < 0.001).

Patients with either an SUD or a trauma-/stress-related diagnosis at the time of delivery had higher readmission rates and overall healthcare utilization compared with patients without these diagnoses. Patients with both diagnoses demonstrated an additive effect on the outcome measures. These findings highlight the need for increased screening and treatment for these conditions in the peripartum period.