Clinical and demographic factors associated with increased risk of postpartum readmission among patients presenting to the emergency department by 6 weeks postpartum.

Abstract

Objective: Postpartum emergency department (ED) visits complicate 12% of births and rates of postpartum readmission are on the rise. While there are a wide range of etiologies, prior studies have sought to delineate causes and risk for readmission. Furthering our understanding of risk factors and etiologies for postpartum readmissions may help develop quality metrics and targeted strategies to address the rising rate of readmissions. We aimed to characterize demographic and perinatal characteristics in postpartum ED visits and evaluate risk factors for readmission.

Methods: A retrospective cohort study was performed on all ED visits that took place within 42 days of delivery at a single tertiary care center between 2017 and 2022. Inclusion criteria were age 18 years or above and both delivery and ED visit/readmission at the institution. Exclusion criteria included patients who did not deliver at the study institution, previable deliveries (<24 weeks gestation), intrauterine fetal demise, and termination of pregnancy. Chief complaint was used to determine the main reason for presentation to the ED. Patients who presented with concern for elevated blood pressures had hypertension listed as their chief complaint. Maternal demographics and delivery outcomes were compared between patients who were readmitted to those managed outpatient.

Results: Of 16162 deliveries, 548 (3.4%) patients presented to the ED for total 616 encounters. 52 (9.5%) patients presented to the ED more than once. Out of the patients who presented to the ED, 221 (40.3%) patients were readmitted, 8 of whom were readmitted twice (1.3%). The majority (63%) of ED visits occurred within 14 days of delivery. Hypertension was the most common reason for presenting to the ED (23.8%), followed by GI complaints (10.8%) and vaginal bleeding (9.7%). Advanced maternal age, higher BMI, Black race, chronic hypertension, maternal medical comorbidity, and longer postpartum length of stay were all associated with higher likelihood of being readmitted. Multivariate logistic regression controlling for potential confounders found higher risk of readmission with hypertensive disorder of pregnancy (adjusted odds ratio [aOR], 2.28; 95% confidence interval [CI], 1.57-3.3; p < 0.001), preeclampsia with severe features (aOR, 1.91; 95% CI, 1.07-3.42; p = 0.03), and presenting for hypertension (aOR, 5.69; 95% CI, 3.56-9.09; p < 0.001). There were also higher odds of readmission with any delivery complication (aOR, 1.77; 95% CI, 1.24-2.52; p = 0.002) and having more than one ED visit (aOR, 3.42; 95% CI, 1.86 to 6.28; p < 0.001).

Conclusion: Most ED visits took place within 2 weeks of delivery, and postpartum hypertension was the leading cause. Risk of readmission after an ED visit was higher for patients with medical comorbidities, hypertensive disorders of pregnancy, and delivery complications. Future research is needed to evaluate patient-centered models to improve outcomes and support patients during the postpartum period.