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1. Maternal Race/Ethnicity, Hypertension, and Risk for Stroke During Delivery Admission

Author

Eliza C. Miller, Maria Daniela Zambrano Espinoza, Yongmei Huang, Alexander M. Friedman, Amelia K. Boehme, Natalie A. Bello, Kirsten L. Cleary, Jason D. Wright, and Mary E. D'Alton

Subjects
disparities, hypertension, maternal morbidity, preeclampsia, pregnancy, stroke, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Racial disparities contribute to maternal morbidity in the United States. Hypertension is associated with poor maternal outcomes, including stroke. Disparities in hypertension might contribute to maternal strokes. Methods and Results Using billing data from the Healthcare Cost and Utilization Project's National Inpatient Sample, we analyzed the effect of race/ethnicity on stroke during delivery admission in women aged 18 to 54 years delivering in US hospitals from January 1, 1998, through December 31, 2014. We categorized hypertension as normotensive, chronic hypertension, or pregnancy‐induced hypertension. Adjusted risk ratios (aRRs) and 95% CIs were calculated using log‐linear Poisson regression models, testing for interactions between race/ethnicity and hypertensive status. A total of 65 286 425 women were admitted for delivery during the study period, of whom 7764 were diagnosed with a stroke (11.9 per 100 000 deliveries). Hypertension modified the effect of race/ethnicity (P

Published
2020
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2. Timing of Maternal Discharge after Cesarean Delivery and Risk of Maternal Readmission

Author

Ayamo Oben, William Perez, Victoria C. Jauk, Kim Boggess, Erin Clark, George Saade, M Sean Esplin, Sherri Longo, Kirsten L. Cleary, Ronald Wapner, Sean C. Blackwell, Michelle Y. Owens, Namasivayam Ambalavanan, Jeff M. Szychowski, and Alan Tita

Subjects
Logistic Models, Cesarean Section, Pregnancy, Pediatrics, Perinatology and Child Health, Infant, Newborn, Obstetrics and Gynecology, Humans, Female, Azithromycin, Patient Readmission, Patient Discharge, Retrospective Studies
Abstract

Objective Despite legislation and hospital policies (present in some institutions) mandating a minimum length of stay in an effort to decrease the frequency of hospital readmissions, the effectiveness of this approach remains uncertain.We hypothesized that following cesarean delivery (CD), the rates of maternal readmission or unscheduled health care visits are lower in patients discharged on postoperative day (POD) 3 or ≥4 as compared with those discharged earlier on POD 2. Methods This is a secondary analysis of a multicenter randomized trial comparing adjunctive azithromycin for unscheduled CD to prevent infection. Groups were compared based on the duration of hospitalization measured in days from delivery (POD 0) to day of discharge and categorized as POD 2, 3, and ≥4. The primary outcome was the composite of any maternal postpartum readmission, unscheduled clinic, or emergency room (ER) visit, within 6 weeks of delivery. Secondary outcomes included components of the primary outcome and neonatal readmissions. We excluded women with hypertensive disorders of pregnancy and infections diagnosed prior to POD 2. Results A total of 1,391 patients were included. The rate of the primary outcome of any readmission increased with POD at discharge: 5.9% for POD 2, 9.4% for POD 3, and 10.9% for POD ≥4 group (trend for p = 0.03). The primary outcome increased with later discharge (POD ≥4 when compared with POD 2). Among components of the composite, ER and unscheduled clinic visits, but not maternal readmissions, increased with the timing of discharge for patients discharged on POD ≥4 when compared with POD 2. Using logistic regression, discharge on POD 3 and on POD ≥4 was significantly associated with the composite (adjusted odds ratios [aOR] 2.6, 95% confidence interval [CI] [1.3–5.3]; aOR 2.9, 95% CI [1.3–6.4], respectively) compared with POD 2. Conclusion The risk of maternal readmission composite following uncomplicated but unscheduled CD was not lower in patients discharged home on POD 3 or ≥4 compared with patients discharged earlier (POD 2). Key Points

Published
2022

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