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Readmissions After Anesthetic Complications During Delivery. A Nationwide Cohort Study from 2013-2014
Abstract Number: O-08
Abstract Type: Original Research
Introduction: In recent years, there has been a marked decline in peripartum anesthetic related mortality (1,2). However, anesthetic related morbidity still exists and outcomes associated with anesthetic complications, specifically subsequent readmissions, are incompletely understood. Using a large national database, we examined risk factors, outcomes, and subsequent 30–day readmissions associated with anesthesia complications during delivery.
METHODS: We performed a retrospective cohort analysis using combined data from the 2013 and 2014 National Readmissions Databases (NRD). For each year, the NRD database provides discharge data on approximately 14 million hospital stays. NRD has data from up to 22 geographically diverse states and represents 49.3% of all US hospitalizations. The NRD can be weighted to produce national estimates.
RESULTS: Of the 70,886,775 weighted national discharges, 6,983133 were 'delivery' discharges in 15-45 year age group. Anesthetic complications occurred in 0.4%, most common being related to: neuraxial anesthesia (50.3%), unspecified complications (45.9%), and cardiopulmonary complications (1.8%). The 30-day readmission rate was 2.9% compared to 1.4% in all parturients. The most common risk factors for readmission included: obesity, severe pre-eclampsia, drug abuse, delivery in a metropolitan hospital, and lower income quartile (Table 1). The median length of stay for readmissions was 1.82 days (1.65-1.99).
The most common reasons for readmission were related to: anesthetic complications (17.5%), surgical complications (8.2%), and eclampsia (6.8%). The most common procedures performed during readmission were epidural blood patch (29.7%) and packed red blood cell transfusion (5.8%).
Although rare, peripartum anesthetic complications contribute to increased resource utilization. Specifically, women who suffer from a peripartum anesthetic related complication are twice as likely to be readmitted compared to all parturients. Endeavors to further reduce anesthetic related complications in this patient population will help reduce overall readmissions after delivery.
1. Mhyre JM1, Bateman BT. Stemming the Tide of Obstetric Morbidity: An opportunity for the Anesthesiologist to Embrace the Role of Peridelivery Physician. Anesthesiology. 2015 Novl123(5):986-9
2. Creanga AA, Berg CJ, Syverson C et al. Pregnancy-Related Mortality in the United States, 2006-10. Obstet Gynecol. 2015 Jan;125(1):5-12