(1054) Postpartum hospital use in the 90 days after delivery

We aimed to perform a health system-wide analysis of sociodemographic, clinical, and hospital-level factors associated with 90-day postpartum emergency department (ED) visits and inpatient hospital admissions.

Study Design:

This cross-sectional study of all 90-day postpartum hospital ED visits and inpatient admissions ("90-day readmission”) in a nine-hospital Midwest health system included all births from 1/2018-6/2023. We applied a multilevel eco-social framework to examine associations between factors in three domains and 90-day readmission. Exposure variables included sociodemographic (age, race/ethnicity, insurance, language, census zip code percent poor households), clinical (body mass index [BMI], severe maternal morbidity during delivery admission [SMM], and other comorbidities), and hospital-level factors. We applied bivariate and adjusted Poisson regression analyses.

Results:

Of 104,076 deliveries, 6,879 (6.6%) were followed by 90-day readmission. In bivariate analysis, chronic hypertension, substance use disorder, BMI >40, and SMM demonstrated the strongest association with 90-day readmission (Figure). After adjusting for all factors under investigation, of sociodemographic factors, Medicaid insurance (adjusted incidence rate ratio [aIRR] 1.43; 95% confidence interval [CI] 1.34-1.45) and Black race (aIRR 1.35; CI 1.25-1.46) were associated with the greatest 90-day readmission risk. SMM remained most strongly associated with 90-day readmission of any factor (aIRR 1.95; 95% CI 1.75-2.18). Chronic hypertension (aIRR 1.59; CI 1.49-1.70) and BMI >40 (aIRR 1.52; CI 1.36-1.70) both had elevated 90-day readmission risk. Primiparity and all other medical comorbidities had relatively weaker associations (Figure). At the hospital level, delivery at a suburban or community hospital was associated with greater 90-day readmission risk than delivery at the academic medical center.

Conclusion:

In this health system-wide analysis, 90-day readmission is driven by a combination of sociodemographic, clinical, and hospital-level factors, underscoring the need for a comprehensive mitigation strategy.