Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth, School of Public Health, Houston, TX, USA.
Paediatr Perinat Epidemiol. 2021 Nov;35(6):627-634. doi: 10.1111/ppe.12762. Epub 2021 Mar 18.
Little is known about the extent to which severe maternal morbidity (SMM) at delivery impacts early and late postpartum readmission.
We examined readmission rates for women with and without SMM (and their 18 subtypes) at delivery and characterised the most common medical reasons for readmissions.
We conducted a retrospective cohort study utilising the 2016-2017 Nationwide Readmissions Database among women giving births in the United States. Deliveries were classified according to the presence or absence of 18 SMM indicators defined by the Centers for Disease Control and Prevention using the International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) diagnosis and procedure codes. The primary outcome of this study was all-cause early (≤7 day) and late (8 to 42 day) postpartum readmission. Survey-weighted Poisson regression with robust error variance was used to generate adjusted risk ratios (RR) and 95% confidence intervals (CI) to investigate the association between SMM and early and late postpartum readmission. Additionally, we compared principal diagnoses codes during readmission hospitalisations among women with and without SMM at delivery.
Of the 6 193 852 women examined, 4.9% (n = 4928) with any SMM and 1.4% (n = 83 995) with no SMM were readmitted within 42 days after delivery. After adjusting for obstetric co-morbidities and sociodemographic factors, women with any SMM were 57% (RR 1.57, 95% CI 1.47, 1.67) more likely to have an early readmission and 69% (RR 1.69, 95% CI 1.57, 1.82) more likely to have a late readmission compared to women with no SMM at delivery. However, the risk was attenuated when excluding women with blood transfusion only. Women with and without SMM were readmitted predominantly for obstetric complications and infections.
Women with SMM at delivery were more likely to experience both early and late postpartum readmission, independent of their obstetrical co-morbidity burden and sociodemographic factors.
对于分娩时发生严重产妇发病率（SMM）对产后早期和晚期再入院的影响程度，我们知之甚少。
我们检查了分娩时患有和不患有 SMM（及其 18 种亚型）的女性的再入院率，并描述了再入院的最常见医学原因。
我们在美国 2016-2017 年全国再入院数据库中进行了一项回顾性队列研究，研究对象为分娩的女性。根据美国疾病控制与预防中心使用国际疾病分类、第十版、临床修订版（ICD-10-CM）诊断和程序代码定义的 18 种 SMM 指标的存在或不存在，对分娩进行分类。本研究的主要结局是所有原因的产后早期（≤7 天）和晚期（8 至 42 天）再入院。使用具有稳健误差方差的调查加权泊松回归生成调整后的风险比（RR）和 95%置信区间（CI），以调查 SMM 与产后早期和晚期再入院之间的关系。此外，我们比较了分娩时患有和不患有 SMM 的女性在再入院住院期间的主要诊断代码。
在 6193852 名接受检查的女性中，有 4.9%（n=4928）患有任何 SMM，1.4%（n=83995）没有 SMM 在分娩后 42 天内再次入院。在调整了产科合并症和社会人口因素后，患有任何 SMM 的女性发生早期再入院的可能性增加了 57%（RR 1.57，95%CI 1.47，1.67），发生晚期再入院的可能性增加了 69%（RR 1.69，95%CI 1.57，1.82）与分娩时没有 SMM 的女性相比。然而，当排除仅输血的女性时，风险会减弱。患有和不患有 SMM 的女性主要因产科并发症和感染而再次入院。
分娩时患有 SMM 的女性更有可能经历产后早期和晚期再入院，而与她们的产科合并症负担和社会人口因素无关。
