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Risk Factors and Indications for Postpartum Readmission: A Retrospective Cohort Study
Abstract Number: O2-03
Abstract Type: Original Research
The Centers for Medicare and Medicaid Services has identified readmissions within 30 days as a marker of healthcare quality and a target for limiting reimbursement. There are few population-level studies examining patterns and predictors of readmission in obstetric patients. The aim of this study was to identify key causes and risk factors for postpartum readmission to serve as targets for subsequent quality improvement initiatives.
Materials and Methods
Data were obtained from the Agency for Healthcare Research and Quality’s California State Inpatient Database. Delivery admissions were identified from 2010- 2011 and linked to readmissions that occurred within 30 days of discharge. Timing and indications for readmission were defined, and associated hospital charges were calculated. Independent predictors of readmission were defined based on patient characteristics, conditions, and complications recorded during the delivery hospitalization using multivariable logistic regression.
There were 731,087 deliveries in the cohort, of which 7,765 (1.1%) were readmitted within 30 days of discharge. The median time to readmission was 7 days (IQR 3-15) with a median length of stay of 2 days (IQR 1-4) and median hospital charges of $24,886 (IQR 14,925-41,909). The most common indication for readmission was infection, at 56.7% (22.1% puerperal). Other leading indications were hypertension (18%), surgical/wound complications (17%), cardiac complications (12%), hemorrhage/retained placenta (9.3%), asthma exacerbation (6.4%) and headache (5.8%).
The logistic regression model predicting readmission had a c-statistic of 0.7, indicating moderate discrimination. Readmission rates were higher at extremes of age, with women <20 (adjusted odds ratio (aOR) 1.21, 95% confidence interval (CI) 1.12 to 1.31) and ≥40 (aOR 1.26, 95% CI 1.14 to 1.39) at increased risk compared to those age 20 to 34. African-Americans were more likely to be readmitted than Caucasians (aOR 1.41, 95% CI 1.3-1.54), as were women with Medicaid insurance (aOR 1.24, 95% CI 1.18-1.31) compared to those with private insurance. Cesarean delivery was associated with an increased incidence of readmission (aOR 1.87, 95% CI 1.78-1.96) compared to vaginal birth. Women with hypertensive disorders of pregnancy, particularly severe preeclampsia (aOR 1.93, 95% CI 1.73-2.15) were at increased risk of readmissions as were those who required blood transfusion (aOR 2.4, 95% CI 2.11-2.72).
Postpartum readmissions are associated with significant healthcare costs. Most readmissions occur soon after discharge, and are concentrated in patients with high risk conditions that are evident at the time of the delivery hospitalization. This suggests that there may be a preventable component to readmissions that could be addressed with careful discharge planning and close follow up of at-risk patients. Further research is needed to identify potential targeted interventions.