Severe maternal morbidity at delivery may increase readmission risk 1 year postpartum

Key takeaways :

• Readmission incidence was higher for women with severe maternal morbidity vs. those without.
• Sepsis and hypertensive disorders were the most common readmission reason for women with severe maternal morbidity.

Severe maternal morbidity at delivery was associated with an increased readmission risk throughout the year after delivery, according to research published in Obstetrics & Gynecology.

“Current evidence suggests that severe maternal morbidity increases the risk of readmission during the first 42 days postpartum. However, there is a dearth of information about the risk of hospital readmission beyond this period. ... Our primary objective was to assess the cumulative risk of postpartum readmission at four separate timepoints in the first year postpartum among patients with and without severe maternal morbidity during the delivery hospitalization,” Brian Druyan, MD, maternal fetal medicine fellow at the University of Miami Miller School of Medicine at Jackson Memorial Hospital, Miami, and colleagues wrote. “Our secondary aim was to identify the most common readmission diagnoses during the traditional postpartum period and the extended postpartum period among patients with and without severe maternal morbidity at delivery.”

Researchers utilized national health care claims data from IBM MarketScan Commercial Research Databases and identified 459,872 delivery hospitalizations occurring between 2016 and 2018 for continuously enrolled individuals aged 15 to 49 years. All women were followed for 365 days after delivery hospital discharge, and researchers calculated cumulative readmission rates for up to 42 days, up to 90 days, up to 180 days and up to 365 days.

In total, 1.1% of women had severe maternal morbidity at delivery, and 2.5% were readmitted to the hospital within 1-year postpartum. Cumulative readmission incidence was higher among women with severe maternal morbidity compared with women without within 42 days (3.5% vs. 1.2%), within 90 days (4.1% vs. 1.4%), within 180 days (5% vs. 1.8%) and within 365 days (6.4% vs. 2.5%).

Those with severe maternal morbidity during delivery hospitalization had a higher likelihood of undergoing cesarean delivery (42.1% vs. 18.2%), to have repeat cesarean delivery (22.8% vs. 15.9%) and to have a longer median length of stay at hospital (4 vs. 2 days). These women also had higher median obstetric comorbidity index scores compared with women without severe maternal morbidity complications (29 vs. 4).

Severe maternal morbidity at delivery was associated with a 40% to 50% increased readmission risk within 42 days (aRR = 1.44; 95% CI, 1.23-1.68), 90 days (aRR = 1.46; 95% CI, 1.26-1.69), within 180 days (aRR = 1.48; 95% CI, 1.30-1.69) and within 365 days (aRR = 1.44; 95% CI, 1.28-1.61) after adjustment.

The most common readmission reasons within 42 and 365 days postpartum for women with severe maternal morbidity were hypertensive disorders (32.4% and 20.4%), sepsis (30.7% and 19.1%), neurologic diagnoses (15.4% and 13.4%), gallbladder and biliary disease (8.8% and 13.7%) and urinary tract infection and pyelonephritis (7.5% and 7.8%).

“Our results reflect the urgency of the maternal health crisis in the United States today and suggest that resources and research should continue to be focused on earlier risk identification, improved discharge planning and expanded access to care in the year after delivery for pregnant and postpartum patients,” the researchers wrote.