(198) Failure-to-rescue following severe cardio-pulmonary morbidity at delivery: Assessment of race and ethnic differences

Objective: To assess the association between race / ethnicity and maternal mortality following severe cardio-pulmonary morbidity at delivery.

Study Design: This cross-sectional study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population included 19,724,839 delivery hospitalizations from 2016-2021. Under the Centers for Disease Control and Prevention-provided definitions of severe maternal morbidity indicators, six severe cardio-pulmonary morbidity subtypes were identified, including acute myocardial infarction, acute respiratory distress syndrome, cardiac arrest / ventricular fibrillation, conversion of cardiac rhythm, heart failure / arrest during surgery or procedure, and pulmonary edema / acute heart failure. Failure-to-rescue, defined as mortality event following these severe cardio-pulmonary events, was assessed by race and ethnicity in multivariable log-Poisson generalized linear model.

Results: A total of 36,090 patients developed severe cardio-pulmonary morbidity, of which Black and Native American patients had the two highest incidence rates followed by Asian, Hispanic, and White (32.2, 31.4, 19.9, 17.5, and 14.3 per 10,000 deliveries, respectively, P< .001) Failure-to-rescue rate following severe cardio-pulmonary morbidity at delivery was highest in Asian (5.8%), followed by Native American (5.3%), Black (4.1%), Hispanic (3.5%), and White (3.2%) (P< .001). In multivariable analysis, Asian (adjusted-OR 1.75, 95%CI 1.45-2.13) and Native American (adjusted-OR 1.68, 95%CI 1.12-2.54) pregnant patients were 75% and 68% more likely to die, respectively, following severe cardio-pulmonary events compared to White pregnant patients.

Conclusion: Our analysis suggest that there are racial and ethnic differences in failure-to-rescue following severe cardio-pulmonary morbidity at delivery: Although the incidence rate was highest in Black pregnant patients, failure-to-rescue risk following with these morbidities was highest in Asian pregnant patients.