Department of Obstetrics and Gynecology, Kaiser Foundation Hospitals, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA (Dr Bruce); Kaiser Permanente Northern California Division of Research, Oakland, CA (Ms Anderson); Division of Obstetric Hospitalists, Department of Obstetrics and Gynecology, The Permanente Medical Group, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA (Dr Stark).
Department of Obstetrics and Gynecology, Kaiser Foundation Hospitals, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA (Dr Bruce); Kaiser Permanente Northern California Division of Research, Oakland, CA (Ms Anderson); Division of Obstetric Hospitalists, Department of Obstetrics and Gynecology, The Permanente Medical Group, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA (Dr Stark).
Am J Obstet Gynecol MFM. 2021 Sep;3(5):100397. doi: 10.1016/j.ajogmf.2021.100397. Epub 2021 May 12.
Postpartum readmission has negative implications for patients and health systems. Previous studies suggest that up to 5% of women with hypertensive disorders of pregnancy experience postpartum readmission. Studies examining factors associated with postpartum readmission for hypertension have had small sample sizes and conflicting results.
This study aimed to characterize the incidence of and risk factors for postpartum readmission for hypertensive disorders of pregnancy among a cohort of women with preexisting hypertensive disorders of pregnancy.
This was a retrospective cohort study of pregnant women with known hypertensive disorders of pregnancy who delivered live births in a large managed care organization in 2018. The primary outcome was hospital readmission for a hypertensive diagnosis or stroke within 42 days after delivery. The primary exposure of interest was persistent postpartum hypertension, defined as a maximum systolic blood pressure of ≥140 mm Hg or maximum diastolic blood pressure of ≥90 mm Hg within 24 hours before discharge from delivery hospitalization. Continuous and categorical variables were compared using bivariate analysis. Risk factors independently associated with postpartum readmission were identified using multivariable logistic regression.
Of 42,022 women who delivered in 2018, 7151 had hypertensive disorders of pregnancy-an incidence of 17%. The rate of postpartum readmission among women with hypertensive disorders of pregnancy was 4.43% (317 of 7151). The following risk factors were associated with increased odds of postpartum readmission in women with hypertensive disorders of pregnancy: systolic blood pressure of ≥140 mm Hg within 24 hours before discharge (adjusted odds ratio, 2.29; 95% confidence interval, 1.71-3.07), diastolic blood pressure of ≥90 mm Hg within 24 hours before discharge (adjusted odds ratio, 1.33; 95% confidence interval, 1.02-1.73), maternal age of ≥30 years (30-34: adjusted odds ratio, 1.57; 95% confidence interval, 1.12-2.19; 35-39: adjusted odds ratio, 2.36; 95% confidence interval, 1.70-3.28; ≥40: adjusted odds ratio, 2.95; 95% confidence interval, 1.95-4.46), receipt of magnesium sulfate (adjusted odds ratio, 1.47; 95% confidence interval, 1.11-1.94), and receipt of inpatient rapid-acting antihypertensive medication (adjusted odds ratio, 1.46; 95% confidence interval, 1.10-1.93). In addition, 1 blood pressure of ≥140/90 mm Hg within 24 hours before discharge increased the odds of readmission (adjusted odds ratio, 1.98; 95% confidence interval, 1.37-2.87). Furthermore, 2 or more elevated blood pressure values further increased the odds (adjusted odds ratio, 3.14; 95% confidence interval, 2.33-4.24). Median postpartum day of readmission was day 5 (interquartile range=3).
Hospital readmission for postpartum hypertension was associated with persistent postpartum hypertension (blood pressure of ≥140/90 mm Hg), increasing maternal age, and more severe antepartum hypertension. Women with these characteristics may be targeted in future quality initiatives to mitigate readmission.
产后再入院对患者和医疗系统都有负面影响。先前的研究表明，高达 5%的妊娠高血压疾病患者会经历产后再入院。研究高血压疾病产后再入院相关因素的研究样本量较小，结果存在冲突。
本研究旨在描述患有妊娠高血压疾病的女性产后再入院的发生率和风险因素，这些女性在分娩前就已经患有高血压疾病。
这是一项对 2018 年在一家大型管理式医疗组织中分娩的已知患有妊娠高血压疾病的孕妇进行的回顾性队列研究。主要结局是产后 42 天内因高血压或中风再次住院。主要暴露因素是产后持续性高血压，定义为分娩住院期间出院前 24 小时内收缩压≥140mmHg 或舒张压≥90mmHg。使用双变量分析比较连续和分类变量。使用多变量逻辑回归确定与产后再入院独立相关的风险因素。
在 2018 年分娩的 42022 名女性中，有 7151 名患有高血压疾病，发病率为 17%。患有高血压疾病的女性产后再入院率为 4.43%（317/7151）。患有高血压疾病的女性产后再入院的风险因素包括：出院前 24 小时内收缩压≥140mmHg（调整后的优势比，2.29；95%置信区间，1.71-3.07）、出院前 24 小时内舒张压≥90mmHg（调整后的优势比，1.33；95%置信区间，1.02-1.73）、产妇年龄≥30 岁（30-34 岁：调整后的优势比，1.57；95%置信区间，1.12-2.19；35-39 岁：调整后的优势比，2.36；95%置信区间，1.70-3.28；≥40 岁：调整后的优势比，2.95；95%置信区间，1.95-4.46）、接受硫酸镁治疗（调整后的优势比，1.47；95%置信区间，1.11-1.94）和接受住院快速降压药物治疗（调整后的优势比，1.46；95%置信区间，1.10-1.93）。此外，出院前 24 小时内血压≥140/90mmHg 会增加再入院的几率（调整后的优势比，1.98；95%置信区间，1.37-2.87）。此外，2 个或更多升高的血压值会进一步增加再入院的几率（调整后的优势比，3.14；95%置信区间，2.33-4.24）。再入院的产后平均天数为第 5 天（中位数=3 天）。
产后高血压导致的医院再入院与持续性产后高血压（血压≥140/90mmHg）、产妇年龄增加和更严重的产前高血压有关。具有这些特征的女性可能是未来质量改善举措的目标，以减轻再入院的风险。
