Panzer Alexis, Reed-Weston Anne, Friedman Alexander, Goffman Dena, Wen Timothy
Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA.
Department of Obstetrics and Gynecology, ChristianaCare, Newark, DE, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):9585-9592. doi: 10.1080/14767058.2022.2048815. Epub 2022 Mar 13.
Early postpartum discharges increased organically during the COVID-19 pandemic. It is not known if this 'natural experiment' of shorter postpartum hospital stays resulted in increased risk for postpartum readmissions and other acute postpartum care utilization such as emergency room encounters.
The objectives of this study were to determine which clinical factors were associated with expedited postpartum discharge and whether the expedited postpartum discharge was associated with increased risk for acute postpartum care utilization.
This retrospective cohort study evaluated birth hospitalizations at affiliated hospitals during two periods: (i) the apex of the 'first wave' of the COVID-19 pandemic in New York City (3/22/20 to 4/30/20) and (ii) a historical control period of one year earlier (3/22/19 to 4/30/19). Routine postpartum discharge was defined as ≥2 d after vaginal birth and ≥3 d after cesarean birth. Expedited discharge was defined as <2 d after vaginal birth and <3 d after cesarean birth. Acute postpartum care utilization was defined as any emergency room visit, obstetric triage visit, or postpartum readmission ≤6 weeks after birth hospitalization discharge. Demographic and clinical variables were compared based on routine versus expedited postpartum discharge. Unadjusted and adjusted logistic regression models were performed to analyze factors associated with (i) expedited discharge and (ii) acute postpartum care utilization. Unadjusted (ORs) and adjusted odds ratios (aORs) with 95% CIs were used as measures of association. Stratified analysis was performed restricted to patients with chronic hypertension, preeclampsia, and gestational hypertension.
A total of 1,358 birth hospitalizations were included in the analysis, 715 (52.7%) from 2019 and 643 (47.3%) from 2020. Expedited discharge was more common in 2020 than in 2019 (60.3% versus 5.0% of deliveries, < .01). For 2020, clinical factors significantly associated with a decreased likelihood of expedited discharge included hypertensive disorders of pregnancy (OR 0.40, 95% CI 0.27-0.60), chronic hypertension (OR 0.14, 95% CI 0.06-0.29), and COVID-19 infection (OR 0.51, 95% CI 0.34-0.77). Cesarean (OR 3.00, 95% CI 2.14-4.19) and term birth (OR 3.34, 95% CI 2.03, 5.49) were associated with an increased likelihood of expedited discharge. Most of the associations retained significance in adjusted models. Expedited compared to routine discharge was not associated with significantly different odds of acute postpartum care utilization for 2020 deliveries (5.4% versus 5.9%; OR 0.92, 95% CI 0.47-1.82). Medicaid insurance (OR 2.30, 95% CI 1.06-4.98) and HDP (OR 5.16, 95% CI: 2.60-10.26) were associated with a higher risk of acute postpartum care utilization and retained significance in adjusted analyses. In the stratified analysis restricted to women with hypertensive diagnoses, expedited discharge was associated with significantly increased risk for postpartum readmission (OR 6.09, 95% CI 2.14, 17.33) but not overall acute postpartum care utilization (OR 2.17, 95% CI 1.00, 4.74).
Expedited postpartum discharge was not associated with increased risk for acute postpartum care utilization. Among women with hypertensive diagnoses, expedited discharge was associated with a higher risk for readmission despite expedited discharge occurring less frequently.
在新冠疫情期间，产后早期出院人数自然增加。目前尚不清楚这种产后住院时间缩短的“自然实验”是否会导致产后再入院风险增加以及其他急性产后护理利用情况增加，如急诊就诊。
本研究的目的是确定哪些临床因素与加速产后出院相关，以及加速产后出院是否与急性产后护理利用风险增加相关。
这项回顾性队列研究评估了两个时期附属医院的分娩住院情况：（i）纽约市新冠疫情“第一波”高峰期（2020年3月22日至4月30日），以及（ii）一年前的历史对照期（2019年3月22日至4月30日）。常规产后出院定义为阴道分娩后≥2天，剖宫产术后≥3天。加速出院定义为阴道分娩后<2天，剖宫产术后<3天。急性产后护理利用定义为出生住院出院后≤6周内的任何急诊就诊、产科分诊就诊或产后再入院。根据常规与加速产后出院情况比较人口统计学和临床变量。进行未调整和调整后的逻辑回归模型分析与（i）加速出院和（ii）急性产后护理利用相关的因素。使用95%置信区间的未调整比值比（OR）和调整后比值比（aOR）作为关联度量。对患有慢性高血压、先兆子痫和妊娠期高血压的患者进行分层分析。
分析共纳入1358例分娩住院病例，2019年715例（52.7%），2020年643例（47.3%）。2020年加速出院比2019年更常见（分娩比例分别为60.3%和5.0%，P<0.01）。对于2020年，与加速出院可能性降低显著相关的临床因素包括妊娠高血压疾病（OR 0.40，95% CI 0.27 - 0.60）、慢性高血压（OR 0.14, 95% CI 0.06 - 0.29）和新冠病毒感染（OR 0.51, 95% CI 0.34 - 0.77）。剖宫产（OR 3.00, 95% CI 2.14 - 4.19）和足月分娩（OR 3.34, 95% CI 2.03, 5.49）与加速出院可能性增加相关。大多数关联在调整模型中仍具有显著性。与2020年分娩的常规出院相比，加速出院与急性产后护理利用的显著不同几率无关（分别为5.4%和5.9%；OR 0.92, 95% CI 0.47 - 1.82）。医疗补助保险（OR 2.30, 95% CI 1.06 - 4.98）和高血压疾病（OR 5.16, 95% CI: 2.60 - 10.26）与急性产后护理利用风险较高相关，且在调整分析中仍具有显著性。在仅限于高血压诊断女性的分层分析中，加速出院与产后再入院风险显著增加相关（OR 6.09, 95% CI 2.14, 17.
