Hospital Readmission Following Delivery With and Without Severe Maternal Morbidity

Abstract

Background: The relationship between severe maternal morbidity (SMM) events during inpatient delivery and subsequent hospital readmission is not well understood. Materials and Methods: This was a retrospective cohort study of women with a live inpatient delivery during 2016 recorded in MarketScan^® databases for commercially insured and Medicaid populations. Live inpatient births were identified by the International Classification of Diseases, 10th Revision diagnostic and procedural codes, Current Procedural Terminology, and Diagnosis-Related Group codes. The incidence of hospital readmission within 30 days following a delivery discharge, and primary discharge diagnoses, were determined by SMM status. The association with hospital readmission of SMM status, delivery type, gestation type, and maternal age was determined in multivariable logistic regression analyses, adjusted for pregnancy-related complications and preexisting comorbidities. Results: In the Commercial population there were 1,927 hospital readmissions, for an incidence rate of 11.7 per 1,000 discharges. The readmission rate was 12 times greater for women with SMM than for women without SMM during delivery. The most frequent discharge diagnoses among women readmitted were other complications of the puerperium, endometritis, and infection of obstetric surgical wound of women without SMM during delivery. In multivariable analysis, SMM during delivery was strongly associated with readmission in the Commercial population. Results for the Medicaid population were similar. Conclusion: SMM during delivery hospitalization increased the risk of readmission more than 10 times. The most frequent discharge diagnoses following readmission included obstetric infection and endometritis in women without SMM, and eclampsia in women with SMM during delivery. Awareness of these findings could help health care providers prevent future episodes.

Keywords: epidemiology; hospital readmission; severe maternal mortality.

FIG. 1.

Most common primary discharge diagnoses for readmissions in the Commercial population. Shown are the 10 most prevalent readmission discharge diagnoses for women with SMM (N = 252) and without SMM (N = 1,675) during delivery hospitalization. SMM, severe maternal morbidity.

FIG. 2.

Most common primary discharge diagnoses for readmissions in the Medicaid population. Shown are the 10 most prevalent readmission discharge diagnoses for women with SMM (N = 145) and without SMM (N = 969) during delivery hospitalization.