Back so soon? Common reasons for postpartum readmission

After spending several days in the hospital, most people are not eager to return for another visit, especially if they are toting a newborn home. However, readmissions after delivery may be more common than you imagine. 2% of hospitalizations for delivery of an infant resulted in a readmission soon after. Is the readmission rate rising? Why are women ending up back in the hospital?

A group of researchers from Harvard School of Public Health and the Harvard-affiliated Brigham and Women's Hospital in Boston studied hospital readmission data from 2004 to 2011 for California, Florida, and New York states (some of the states with the most deliveries nationwide). A "postpartum readmission" was defined as a hospital stay within 6 weeks after delivery of an infant. There were over 5.9 million deliveries in the 8-year database, and over 114,000 readmissions, resulting in about a 2% readmission rate. 

Of their many interesting findings, the authors learned that the readmission rate has been rising over time. In 2004, the readmission rate was 1.72%, and in 2011, the rate increased to 2.16%. Therefore, over the 8 years of the study, a new mother's risk of postpartum readmission increased by 26%. 

Not every mother was equally likely to be readmitted. As you might imagine, women with medical complications, like high blood pressure and diabetes, were more likely to be readmitted. Women who were readmitted were more likely to have had a cesarean delivery. They were also more likely to have black race and to be publicly insured. Overall, the women most likely to be readmitted to the hospital were those with psychiatric disease, a substance use disorder, seizure disorder, high blood pressure, or tobacco use.

The most common reason for readmission was infection, followed by high blood pressure, and then psychiatric illness. The reason for readmission influenced how many days after initial discharge women returned to the hospital. For instance, women were readmitted after 1 week on average, overall. However, women who were readmitted for high blood pressure tended to return quickly- just 3 days after discharge. On the other hand, women who were readmitted for psychiatric illness were home longer, with an average readmission 9 days after initial discharge.

Although the absolute increase in readmissions (1.72% to 2.16%) seems pretty small, it's actually a lot of people. Since about 4 million infants are born in the US each year, about 17,600 more new mothers were readmitted to the hospital in 2011 than in 2004. Other research has shown that pregnant women have more preexisting medical conditions now than in the past, which is likely contributing to the rise in the readmission rate.  Nevertheless, this new research could help healthcare providers to identify new moms who are at the highest risk of readmission, enabling them to intervene and help earlier and hopefully avoid a readmission.

We want to hear from you! What do you think is contributing most to the increasing postpartum readmission rate?