Medical problems drive up postpartum readmission rate

By Eva Martin, MD of Elm Tree Medical Inc.

Health policy nerds throughout the country have been excited about hospital readmission rates for years. Hospital readmissions represent significant difficulties for patients and cost centers for payors. With about four million deliveries a year in the United States, hospitalization for childbirth is the most common reason for hospitalization for healthy, young women. A new study has revealed that the readmission rate for this large cohort of patients has risen significantly in the last few years.

Dr. Mark Clapp, a resident at Brigham and Women’s Hospital, a Harvard Medical School affiliate, presented the findings of this new study at the 2016 annual meeting of the American College of Obstetricians and Gynecologists. The study analyzed readmissions in California, Florida, and New York. Why just three states? Well, these three states account for about one quarter of all deliveries in the US! In 2004, the postpartum readmission rate was 1.75%. In 2011, the rate rose to 2.16%, which represents a 26% increase. Half of the readmissions occurred in the first week after discharge, and the remaining half occurred in the next five weeks.

The most common cause for readmission was a wound infection or wound breakdown, making up 15.5% of readmissions. High blood pressure and psychiatric illness followed as the second and third most common causes for readmission.

Who is most likely to need to be readmitted to the hospital after giving birth? The biggest risk factor was an existing medical problem. High blood pressure, psychiatric disease, and substance abuse were associated with the highest risk of readmission. However, other medical problems such as asthma, diabetes, obesity, and thyroid disease were also associated with a higher risk of readmission. Other factors associated with needing to be readmitted to the hospital after delivery were having public insurance, older age, and black race. Women with twins or triplets, preterm labor, or a problem with the placenta were also more likely to be readmitted. Cesarean delivery was controversial. 37% of women who were readmitted had a cesarean delivery, and 33% of women who were not readmitted had a c-section. However, the relationship between cesarean delivery and readmission was inconsistent. For example, Floridians who had a c-section were actually less likely than women who had a vaginal delivery to be readmitted.

The jury is still out on whether readmission rates are a good outcome measure for assessing hospitals and physicians. Many factors influence a woman’s risk of readmission, many of which are not dependent on the care they receive. Only time will tell whether future research will support or refute this metric as a good way to measure healthcare quality for obstetrics.