Division of Neonatology, the Children's Hospital of Philadelphia, the Perelman School of Medicine at the University of Pennsylvania, the Leonard Davis Institute of Health Economics, the Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, the Division of Neonatology, Nemours duPont Pediatrics, and Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Epic Systems, Verona, Wisconsin; and the Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.
Obstet Gynecol. 2022 Mar 1;139(3):381-390. doi: 10.1097/AOG.0000000000004687.
To compare postpartum hospitalization length of stay (LOS) and hospital readmission among obstetric patients before (March 2017-February 2020; prepandemic) and during the coronavirus disease 2019 (COVID-19) pandemic (March 2020-February 2021).
We conducted a retrospective cohort study, using Epic Systems' Cosmos research platform, of obstetric patients who delivered between March 1, 2017, and February 28, 2021, at 20-44 weeks of gestation and were discharged within 7 days of delivery. The primary outcome was short postpartum hospitalization LOS (less than two midnights for vaginal births and less than three midnights for cesarean births) and secondary outcome was hospital readmission within 6 weeks of postpartum hospitalization discharge. Analyses compared outcomes before and during the pandemic using standardized differences and Bayesian logistic mixed-effects models, among all births and stratified by mode of delivery.
Of the 994,268 obstetric patients in the study cohort, 742,113 (74.6%) delivered prepandemic and 252,155 (25.4%) delivered during the COVID-19 pandemic. During the COVID-19 pandemic, the percentage of short postpartum hospitalizations increased among all births (28.7-44.5%), vaginal births (25.4-39.5%), and cesarean births (35.3-55.1%), which was consistent with the adjusted analysis (all births: adjusted odds ratio [aOR] 2.35, 99% credible interval 2.32-2.39; vaginal births: aOR 2.14, 99% credible interval 2.11-2.18; cesarean births aOR 2.90, 99% credible interval 2.83-2.98). Although short postpartum hospitalizations were more common during the COVID-19 pandemic, there was no change in readmission in the unadjusted (1.4% vs 1.6%, standardized difference=0.009) or adjusted (aOR 1.02, 99% credible interval 0.97-1.08) analyses for all births or when stratified by mode of delivery.
Short postpartum hospitalization LOS was significantly more common during the COVID-19 pandemic for obstetric patients with no change in hospital readmissions within 6 weeks of postpartum hospitalization discharge. The COVID-19 pandemic created a natural experiment, suggesting shorter postpartum hospitalization may be reasonable for patients who are self-identified or health care professional-identified as appropriate for discharge.
比较新冠肺炎疫情大流行前后（2017 年 3 月至 2020 年 2 月；大流行前；2020 年 3 月至 2021 年 2 月）产科患者的产后住院时间（LOS）和住院后 6 周内的再入院率。
我们采用回顾性队列研究，使用 Epic Systems 的 Cosmos 研究平台，对 20-44 周妊娠期内分娩且产后 7 天内出院的产科患者进行研究。主要结局是产后 LOS 较短（阴道分娩少于两个午夜，剖宫产分娩少于三个午夜），次要结局是产后住院后 6 周内再入院。采用标准化差异和贝叶斯逻辑混合效应模型，对所有分娩和分娩方式进行分层，比较大流行前后的结局。
在研究队列的 994268 例产科患者中，742113 例（74.6%）在大流行前分娩，252155 例（25.4%）在 COVID-19 大流行期间分娩。在 COVID-19 大流行期间，所有分娩（28.7%-44.5%）、阴道分娩（25.4%-39.5%）和剖宫产分娩（35.3%-55.1%）的产后住院时间较短，这与调整后的分析结果一致（所有分娩：调整后比值比[aOR]2.35，99%可信区间 2.32-2.39；阴道分娩：aOR 2.14，99%可信区间 2.11-2.18；剖宫产分娩：aOR 2.90，99%可信区间 2.83-2.98）。尽管 COVID-19 大流行期间产后住院时间较短，但未经调整（1.4%比 1.6%，标准化差异=0.009）或调整（aOR 1.02，99%可信区间 0.97-1.08）分析的所有分娩或按分娩方式分层后，再入院率均无变化。
COVID-19 大流行期间，产科患者的产后住院 LOS 明显缩短，但产后住院后 6 周内的再入院率没有变化。COVID-19 大流行提供了一个自然实验，表明对于自我认定或被卫生保健专业人员认定为适合出院的患者，缩短产后住院时间可能是合理的。
