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. 2024 Mar 1;143(3):346-354.
doi: 10.1097/AOG.0000000000005437. Epub 2023 Nov 9.

Risk Factors, Trends, and Outcomes Associated With Postpartum Sepsis Readmissions

Lilly Y Liu  1 , Timothy Wen, Uma M Reddy, Mirella Mourad, Dena Goffman, Lisa Nathan, Jean-Ju Sheen, Mary E D'Alton, Alexander M Friedman
Affiliations

Risk Factors, Trends, and Outcomes Associated With Postpartum Sepsis Readmissions

Lilly Y Liu et al. Obstet Gynecol. .

Abstract

Objective: To evaluate the prevalence, timing, clinical risk factors, and adverse outcomes associated with postpartum readmissions for maternal sepsis.

Methods: We conducted a retrospective cohort study of delivery hospitalizations and 60-day postpartum readmissions for females aged 15-54 years with and without sepsis using the 2016-2020 Nationwide Readmissions Database. Temporal trends in sepsis diagnoses during delivery hospitalizations and 60-day postpartum readmissions were analyzed with the National Cancer Institute's Joinpoint Regression Program to estimate the average annual percent change with 95% CIs. Logistic regression models were fit to determine whether delivery hospitalization characteristics were associated with postpartum sepsis readmissions, and unadjusted and adjusted odds ratios with 95% CIs were reported. Adverse outcomes associated with sepsis during delivery hospitalization and readmission were described, including death, severe morbidity, a critical care composite, and renal failure.

Results: Overall, 15,268,190 delivery hospitalizations and 256,216 associated 60-day readmissions were included after population weighting, of which 16,399 (1.1/1,000 delivery hospitalizations) had an associated diagnosis of sepsis at delivery, and 20,130 (1.3/1,000 delivery hospitalizations) had an associated diagnosis of sepsis with postpartum readmission. A sepsis diagnosis was present in 7.9% of all postpartum readmissions. Characteristics associated with postpartum sepsis readmission included younger age at delivery, Medicaid insurance, lowest median ZIP code income quartile, and chronic medical conditions such as obesity, pregestational diabetes, and chronic hypertension. Postpartum sepsis readmissions were associated with infection during the delivery hospitalization, including intra-amniotic infection or endometritis, wound infection, and delivery sepsis. Sepsis diagnoses were associated with 24.4% of maternal deaths at delivery and 38.4% postpartum, 2.2% cases of nontransfusion severe morbidity excluding sepsis at delivery and 13.6% postpartum, 15.6% of critical care composite diagnoses at delivery and 30.1% postpartum, and 11.1% of acute renal failure diagnoses at delivery and 36.4% postpartum.

Conclusion: Sepsis accounts for a significant proportion of postpartum readmissions and is a major contributor to adverse outcomes during delivery hospitalizations and postpartum readmissions.

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Conflict of interest statement

Financial Disclosure Mary E. D'Alton had a senior leadership role in ACOG II's Safe Motherhood Initiative, which received unrestricted funding from Merck for Mothers. Alexander Friedman is supported by funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (1R01HD104943); however, this funding was not used to support this research. He reports serving on a panel for Sage Therapeutics and Biogen. Timothy Wen serves as a consultant on the medical advisory board for Delfina, Inc. Dena Goffman serves on the scientific advisory board for the Jada device through Organon and the Cooper Surgical Obstetrical Safety Council. She reports that her institution received funding from the NICHD EnCore Moms maternal sepsis and the NICHD Obstetric Hemorrhage Technical Skill Simulation. Lisa Nathan reports receiving payment from Organon. Jean Ju Sheen reports receiving payment from UpToDate. Money was paid to their institution from Materna Medical (clinical trial for Prep vaginal dilator device in labor). The other authors did not report any potential conflicts of interest.

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