A multi-state analysis of postpartum readmissions in the United States
A multi-state analysis of postpartum readmissions in the United States
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DOI：
10.1016/j.ajog.2016.01.174
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发表时间：
2016-07-01
影响因子：
9.8
通讯作者：
Robinson, Julian N.
中科院分区：
文献类型：
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作者：
Clapp, Mark A.;Little, Sarah E.;Robinson, Julian N.
背景：再住院率被用作内科和外科专科的质量指标；然而，关于产科再入院的研究知之甚少。目的：本研究的目标是描述产后再入院的趋势；描述再入院的常见指征和相关诊断；并确定可能与再入院相关的产妇、分娩和医院特征。STUDY设计：在加州、佛罗里达和纽约的产后6周内再次入院的情况在2004年至2011年期间在国家住院患者数据库中确定。在5,949,739名符合条件的分娩中，114,748名妇女在8年内再次入院。我们计算了按州和随时间推移的再入院率和他们的指征。再次住院的特征，包括再次住院日、再次住院时间和再次住院费用，在不同的诊断中进行比较。结果：再入院率从2004年的1.72%上升到2011年的2.16%。再次入院的患者更有可能是公共保险(54.3%比42.0%，P<；.001)，黑人(18.7%比13.5%，P<；.001)，合并高血压(15.3%比2.4%，P<；0.001)和糖尿病(13.1%比6.8%，P<；.001)，并有剖腹产(37.2%比32.9%，P<；.001)。再次住院的最常见指征是感染(15.5%)、高血压(9.3%)和精神疾病(7.7%)。患者平均在出院后7天再次入院，但重新入院的天数因诊断而不同：高血压的第3天，感染的第5天，精神疾病的第9天。母亲的合并症是产后再住院的最强预测因素：精神疾病、药物使用、癫痫、高血压和吸烟。结论：产后再住院率在过去8年中有所上升。了解产后再住院的危险因素、病因和特定原因的时间可能有助于制定新的产科质量指标和有针对性的战略，以遏制美国产后再住院率的上升。
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.