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Risk of postpartum readmissions among with with opioid abuse and dependence
Abstract Number: S3B-1
Abstract Type: Original Research
Background: While opioid use during pregnancy is a growing public health concern, how opioid abuse is associated with risk for postpartum readmission is unknown. The purpose of this study was to determine whether opioid abuse and dependence are associated with increased risk for postpartum readmissions.
Methods: We queried the 2010 to 2014 abstracts of the Nationwide Readmissions Database for delivery hospitalizations. Our primary exposure of interest was the presence of opioid dependence, abuse, or overdose based on ICD-9-CM codes during delivery hospitalizations. Our primary outcomes of interest were 60-day postpartum readmissions for (i) any cause, (ii) opioid abuse or overdose, and (ii) severe maternal morbidity using Centers for Disease Control and Prevention criteria. We calculated unadjusted risk ratios (RR) with 95% confidence intervals (CI) as measures of effect. We then fit log-linear multiple regression analyses to determine adjusted risk ratios (aRR) with 95% CIs. Demographic, hospital, and obstetric and medical factors were included in the adjusted models.
Results: 15.7 million deliveries were identified from 2010 to 2014. For all patients, 60-day readmission risks for (i) any cause, (ii) opioid abuse, and (iii) SMM were 1.72%, 0.01%, and 0.23%, respectively. Comparing to patients without opioid dependence or abuse, patients with these conditions were 149% (RR 2.49, 95% CI 2.40-2.58) more likely to be readmitted for any cause and 262% (RR 3.62, 95% 3.31-3.96) to be readmitted with severe morbidity. These patients were also 133 times more likely to be readmitted for drug abuse or overdose (RR 133.4, 95% CI 114.6-155.3). These associations were retained in adjusted models with opioid abuse and dependence associated with increased risk for any-cause readmission (aRR 2.18, 95% CI 2.09-2.25), readmission with severe morbidity (aRR 2.90, 95% CI 2.65-3.17), and readmission for substance abuse (aRR 81.9, 95% CI 69.8-96.3).
Conclusions: Opioid dependence and abuse are associated with increased risk for postpartum admission in general and severe morbidity in particular. Women at risk for postpartum readmission for opioid and dependence may be able to be identified during delivery hospitalizations. Optimization of care for women with these conditions may represent an important component of overall strategies to reduce maternal risk.