当前位置： SCI文献检索 > AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY期刊下所有文献 > A multi-state analysis of postpartum readmissions in the United States.

A multi-state analysis of postpartum readmissions in the United States.

Abstract：

BACKGROUND:Readmission rates are used as a quality metric in medical and surgical specialties; however, little is known about obstetrics readmissions. OBJECTIVE:Our goals for this study were to describe the trends in postpartum readmissions over time; to characterize the common indications and associated diagnoses for readmissions; and to determine maternal, delivery, and hospital characteristics that may be associated with readmission. STUDY DESIGN:Postpartum readmissions occurring within the first 6 weeks after delivery in California, Florida, and New York were identified between 2004 and 2011 in State Inpatient Databases. Of the 5,949,739 eligible deliveries identified, 114,748 women were readmitted over the 8-year period. We calculated the rates of readmissions and their indications by state and over time. The characteristics of the readmission stay, including day readmitted, length of readmission, and charge for readmission, were compared among the diagnoses. Odds ratios were calculated using a multivariate logistic regression to determine the predictors of readmission. RESULTS:The readmission rate increased from 1.72% in 2004 to 2.16% in 2011. Readmitted patients were more likely to be publicly insured (54.3% vs 42.0%, P < .001), to be black (18.7% vs 13.5%, P < .001), to have comorbidities such as hypertension (15.3% vs 2.4%, P < 0.001) and diabetes (13.1% vs 6.8%, P < .001), and to have had a cesarean delivery (37.2% vs 32.9%, P < .001). The most common indications for readmission were infection (15.5%), hypertension (9.3%), and psychiatric illness (7.7%). Patients were readmitted, on average, 7 days after discharge, but readmission day varied by diagnosis: day 3 for hypertension, day 5 for infection, and day 9 for psychiatric disease. Maternal comorbidities were the strongest predictors of postpartum readmissions: psychiatric disease, substance use, seizure disorder, hypertension, and tobacco use. CONCLUSION:Postpartum readmission rates have risen over the last 8 years. Understanding the risk factors, etiologies, and cause-specific timing for postpartum readmissions may aid in the development of new quality metrics in obstetrics and targeted strategies to curb the rising rate of postpartum readmissions in the United States.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

Clapp MA,Little SE,Zheng J,Robinson JN

doi

10.1016/j.ajog.2016.01.174

subject

Has Abstract

pub_date

2016-07-01 00:00:00

pages

113.e1-113.e10

issue

eissn

0002-9378

issn

1097-6868

pii

S0002-9378(16)00224-6

journal_volume

215

pub_type

杂志文章

在线工具

A multi-state analysis of postpartum readmissions in the United States.