Rutgers University, School of Public Health, Piscataway, New Jersey, USA.
Center for Observational and Real-World Evidence (CORE), Merck and Co., Inc., Kenilworth, New Jersey, USA.
J Womens Health (Larchmt). 2021 Dec;30(12):1736-1743. doi: 10.1089/jwh.2020.8815. Epub 2021 May 11.
The relationship between severe maternal morbidity (SMM) events during inpatient delivery and subsequent hospital readmission is not well understood. This was a retrospective cohort study of women with a live inpatient delivery during 2016 recorded in MarketScan databases for commercially insured and Medicaid populations. Live inpatient births were identified by the International Classification of Diseases, 10th Revision diagnostic and procedural codes, Current Procedural Terminology, and Diagnosis-Related Group codes. The incidence of hospital readmission within 30 days following a delivery discharge, and primary discharge diagnoses, were determined by SMM status. The association with hospital readmission of SMM status, delivery type, gestation type, and maternal age was determined in multivariable logistic regression analyses, adjusted for pregnancy-related complications and preexisting comorbidities. In the Commercial population there were 1,927 hospital readmissions, for an incidence rate of 11.7 per 1,000 discharges. The readmission rate was 12 times greater for women with SMM than for women without SMM during delivery. The most frequent discharge diagnoses among women readmitted were other complications of the puerperium, endometritis, and infection of obstetric surgical wound of women without SMM during delivery. In multivariable analysis, SMM during delivery was strongly associated with readmission in the Commercial population. Results for the Medicaid population were similar. SMM during delivery hospitalization increased the risk of readmission more than 10 times. The most frequent discharge diagnoses following readmission included obstetric infection and endometritis in women without SMM, and eclampsia in women with SMM during delivery. Awareness of these findings could help health care providers prevent future episodes.
严重产妇发病率（SMM）事件与住院分娩后再次入院之间的关系尚不清楚。这是一项回顾性队列研究，研究对象为 2016 年市场扫描数据库中商业保险和医疗补助人群中记录的住院分娩的活产妇女。活产通过国际疾病分类第 10 版诊断和程序代码、当前程序术语和诊断相关组代码确定。通过 SMM 状态确定产后 30 天内再次入院和主要出院诊断的发生率。通过多变量逻辑回归分析确定 SMM 状态、分娩类型、妊娠类型和产妇年龄与再次入院的相关性，并调整了妊娠相关并发症和预先存在的合并症。在商业人群中，有 1927 例再次入院，发病率为每 1000 例出院 11.7 例。SMM 产妇的再入院率比无 SMM 产妇高 12 倍。无 SMM 产妇分娩后再次入院的最常见出院诊断是产褥期其他并发症、子宫内膜炎和产科手术伤口感染。在多变量分析中，分娩期间的 SMM 与商业人群的再入院密切相关。医疗补助人群的结果相似。分娩期间的 SMM 住院使再次入院的风险增加了 10 多倍。再次入院后的最常见出院诊断包括无 SMM 产妇的产科感染和子宫内膜炎，以及 SMM 产妇的子痫。了解这些发现可能有助于医疗保健提供者预防未来的发病。
