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217: Does the increasing cesarean delivery rate explain the increasing rate of postpartum readmissions?

      Objective

      To determine if the increasing cesarean delivery rate in the US explains the increasing rate of postpartum readmissions.

      Study Design

      This retrospective cohort study between 2004-2011 identified deliveries in State Inpatient Databases in California, Florida, and New York. Maternal comorbidities, pregnancy characteristics, and mode of delivery were captured using ICD-9 codes. A postpartum readmission was defined as any admission within 6 weeks of delivery. The effects of cesarean delivery were first assessed via univariate logistic regression to calculate the odds of readmission for patients who had a cesarean delivery by year. Then, multivariate logistic regression models accounting for the effects of demographics, maternal comorbidities, and mode of delivery by year were compared.

      Results

      Nearly one million deliveries a year were identified, and approximately 600,000 deliveries per year met all inclusion criteria. During this time period, postpartum readmissions increased from 1.72% to 2.16%, and the cesarean delivery rate increased from 30.4% to 33.9%. The odds of readmission for cesarean delivery decreased each year, from 1.343 (95%CI 1.295-1.392) in 2004 to 1.046 (95%CI 1.012-1.108) in 2011, as shown in the figure. In a multivariate model accounting for demographic and hospital characteristics, the odds of readmission based on year was 1.032 (95%CI 1.030-1.035). When cesarean delivery was added to the model, the odds based on year did not change (OR 1.031, 95%CI 1.028-1.035), suggesting mode of delivery had a minimal effect for the increasing readmission rate over time. However, when maternal comorbidities were added to the model, the odds ratio for year became insignificant (OR 1.001, 95%CI 0.998-1.005), suggesting that maternal comorbidities are the main driver of the increasing rate of postpartum readmissions. The maternal comorbidities with the highest odds of readmission were psychiatric disease (OR 2.542), substance abuse (OR 2.016), seizure disorder (OR 1.989), hypertension (OR 1.886), and tobacco use (OR 1.859).

      Conclusion

      The increasing cesarean delivery rate between 2004 and 2011 does not explain the increasing rate of postpartum readmissions. Rather, the increasing postpartum readmission rate appears to be related to the increasing prevalence of maternal comorbidities.
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