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Sequelae after cardiac arrest amongst parturients: Nationwide Readmissions Database study 2013-2014
Abstract Number: SAT-34
Abstract Type: Original Research
Cardiac arrest during delivery is a rare event. While recent studies have examined risk factors for cardiac arrest among parturients, the literature regarding readmissions from such events is scant.
We performed a retrospective analysis of combined data from 2013 and 2014 National Readmission databases (NRD) to calculate 30 day readmission rate and evaluate reasons for readmission amongst women 15-45 years of age who suffered cardiac arrest during admission for delivery. We also analyzed risk factors for not being discharged alive from such admissions.
NRD databases provides discharge data on approximately 14 million hospital stays for each year. The NRD is maintained by the Healthcare Utilization Project’s Agency for Healthcare and Quality and Research, represents 49% of US hospitalizations, and has data from up to 22 geographically diverse states and. The NRD can be weighted to produce national estimates. Analyses were performed using SAS 9.4 and SUDAAN 11.1. Weighted estimates were utilized to adjust for design effects of the sampling.
Of the 70,886,775 weighted national discharges, 6,983,133 were for delivery in the 15-45 year age group.
Cardiac arrest occurred at the rate of 13.4 per 100,000 deliveries. 58.7% of arrest patients survived to discharge. Venous thromboembolism (OR=3.6), age between 35-45 years (OR=3.57), chronic renal disease (OR=2.66), and sepsis (OR=1.9) were more common amongst non-survivors (Table 1).
The 30-day readmission rate was 10.78%. Baseline readmission rates among women who delivered but did not have cardiac arrest was 1.4%. 92% of readmissions were non-elective. The median interval from discharge to readmission was 8 days (10th-90th centile: 1-27 days).
The primary reasons for readmission were infection (29.7%), cardiac disease (18.6%), thromboembolism (12.32%).
The most common procedures performed during readmission were related to respiratory support (9.4%), packed red cell transfusion 8.5% and central line placement 3.2%.
The median length of stay at readmission was 4.87 days (95% CI: 3.18-6.56 days). 97% of patients were discharged alive on first readmission.
Readmission rates are very high among post-partum women who survive an initial arrest occurring during admission for delivery. Infection, cardiac disease and VTE are the most common reason for readmission. Further work is needed to better understand risk factors for readmission after admission for delivery