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Postpartum readmission rates and inpatient mortality in pregnancies complicated by sickle cell disease: A multistate analysis 2007-2014
Abstract Number: T1A-95
Abstract Type: Original Research
Sickle cell disease (SCD) in pregnancy has been associated with increased maternal mortality and morbidity. Previous studies have reported increased hospital admissions and length of stay (LOS) in sickle cell patients throughout pregnancy due to sickle cell and pain crises, which are known to occur more frequently in pregnancy. In this study, we aimed to compare post-partum outcomes between SCD and non-sickle cell populations.
We conducted a retrospective analysis of discharge data for 6,911,916 inpatient deliveries in the states of California, Florida, New York, Maryland, and Kentucky from 2007 to 2014 using data from the State Inpatient Databases Healthcare Cost and Utilization Project. We compared unadjusted rates and adjusted odds of 30- and 90-day readmission rates, in-hospital mortality, LOS, and total hospital charges in SCD, sickle cell trait, and non-sickle cell patients.
The incidence of SCD was 0.1% (4,758 patients). The inpatient mortality rate was 0.3% in the SCD group. Compared to non-sickle cell patients, SCD patients were nearly five times more likely to die in-hospital (aOR: 4.92, 95% CI: 2.65-9.15, p < 0.001), 26% more likely to be readmitted up to 30 days post-delivery (aOR: 1.26, 95% CI: 1.12-1.42, p < 0.001), and 90% more likely to be readmitted up to 90 days post-delivery (95% CI: 1.73-2.08, p < 0.01). The SCD group had a longer median LOS (3 days, IQR: 2-5) vs. 2 days (IQR: 2-3) in the non-SCD group, and greater median total hospital charges, SCD: $17,808 (IQR: $10,490-$30,125) vs. non-SCD $13,365 (IQR: $8,526-$20,798). SCD patients were 1.32 times more likely than non-sickle cell patients to experience a minor complication such as deep venous thrombosis, urinary tract infections, sepsis/shock (95% CI: 1.89-2.85, p < 0.001), and 2.44 times more likely to experience a major complication such as pneumonia, cardiac arrest, stroke, and mechanical ventilation (95% CI: 2.88-4.11, p < 0.001).
Patients with sickle cell trait were more likely to be readmitted at both 30 and 90 days (aOR: 1.12, 95% CI: 1.04-1.21, and aOR: 1.09, 95% CI: 1.03-1.17, p < 0.001, respectively) and experience a major complication (aOR 1.34, 95% CI: 1.15-1.57, p < 0.001).
SCD in pregnancy is associated with increased inpatient mortality, LOS, hospital charges, and postpartum complications and readmissions. The presence of sickle cell trait was associated with a significant but smaller likelihood of morbidity. Our findings confirm disparate outcomes in sickle cell pregnancies and provide further insight into the impact of SCD on patterns of healthcare utilization.
1. Oteng-Ntim E, Meeks D, Seed PT, et al. Adverse maternal and perinatal outcomes in pregnant women with sickle cell disease: Systematic review and meta-analysis. Blood. 2015;125(21):3316-3325.
2. Villers MS, Jamison MG, De Castro LM, James AH. Morbidity associated with sickle cell disease in pregnancy. Am J Obstet Gynecol. 2008;199(2):1-5.