Druyan Brian, Platner Marissa, Jamieson Denise J, Boulet Sheree L
University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida; and the Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
Obstet Gynecol. 2023 May 1;141(5):949-955. doi: 10.1097/AOG.0000000000005150. Epub 2023 Apr 5.
To conduct a cohort study to estimate risk for readmission through 1 year postpartum and the most common readmission diagnoses for individuals with and without severe maternal morbidity (SMM) at delivery.
Using national health care claims data from IBM MarketScan Commercial Research Databases (now known as Merative), we identified all delivery hospitalizations for continuously enrolled individuals 15-49 years of age that occurred between January 1, 2016, and December 31, 2018. Severe maternal morbidity at delivery was identified using diagnosis and procedure codes. Individuals were followed for 365 days after delivery discharge, and cumulative readmission rates were calculated for up to 42 days, up to 90 days, up to 180 days, and up to 365 days. We used multivariable generalized linear models to estimate adjusted relative risks (aRR), adjusted risk differences, and 95% CIs for the association between readmission and SMM at each of the timepoints.
The study population included 459,872 deliveries; 5,146 (1.1%) individuals had SMM during the delivery hospitalization, and 11,603 (2.5%) were readmitted within 365 days. The cumulative incidence of readmission was higher in individuals with SMM than those without at all timepoints (within 42 days: 3.5% vs 1.2%, aRR 1.44, 95% CI 1.23-1.68; within 90 days: 4.1% vs 1.4%, aRR 1.46, 95% CI 1.26-1.69); within 180 days: 5.0% vs 1.8%, aRR 1.48, 95% CI 1.30-1.69; within 365 days: 6.4% vs 2.5%, aRR 1.44, 95% CI 1.28-1.61). Sepsis and hypertensive disorders were the most common reason for readmission within 42 and 365 days for individuals with SMM (35.2% and 25.8%, respectively).
Severe maternal morbidity at delivery was associated with increased risk for readmission throughout the year after delivery, a finding that underscores the need for heightened awareness of risk for complications beyond the traditional 6-week postpartum period.
开展一项队列研究，以评估产后1年内再次入院的风险，以及分娩时有和没有严重孕产妇发病（SMM）的个体最常见的再次入院诊断。
利用IBM MarketScan商业研究数据库（现称为Merative）中的国家医疗保健索赔数据，我们确定了2016年1月1日至2018年12月31日期间15 - 49岁连续参保个体的所有分娩住院情况。通过诊断和手术编码确定分娩时的严重孕产妇发病情况。个体在分娩出院后随访365天，并计算42天内、90天内、180天内和365天内的累积再入院率。我们使用多变量广义线性模型来估计每个时间点再次入院与SMM之间关联的调整相对风险（aRR）、调整风险差异和95%置信区间（CI）。
研究人群包括459,872例分娩；5146例（1.1%）个体在分娩住院期间发生SMM，11,603例（2.5%）在365天内再次入院。在所有时间点，发生SMM的个体再次入院的累积发生率均高于未发生SMM的个体（42天内：3.5%对1.2%，aRR 1.44，95% CI 1.23 - 1.68；90天内：4.1%对1.4%，aRR 1.46，95% CI 1.26 - 1.69；180天内：5.0%对1.8%，aRR 1.48，95% CI 1.30 - 1.69；365天内：6.4%对2.5%，aRR 1.44，95% CI 1.28 - 1.61）。脓毒症和高血压疾病是发生SMM的个体在42天内和365天内再次入院的最常见原因（分别为35.2%和25.8%）。
分娩时的严重孕产妇发病与分娩后全年再次入院风险增加相关，这一发现强调了需要提高对传统产后6周后并发症风险的认识。
