Am J Perinatol 2019; 36(11): 1115-1119
DOI: 10.1055/s-0039-1683391
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Incidence and Risk Factors for Hospital Readmission or Unexpected Visits in Women Undergoing Unscheduled Cesarean Delivery

Mauricio La Rosa
1   Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
,
Victoria Jauk
2   Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama
,
George R. Saade
1   Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
,
Kim Boggess
3   Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Sherri Longo
4   Oshner Health System, New Orleans, Louisiana
,
Erin A. S. Clark
5   Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
6   Intermountain Health–LC, Salt Lake City, Utah
,
Sean Esplin
5   Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
6   Intermountain Health–LC, Salt Lake City, Utah
,
Kirsten Cleary
7   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Ronald Wapner
7   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Kellet Letson
8   Department of Obstetrics and Gynecology, Mission Hospital, Asheville, North Carolina
,
Michelle Y. Owens
9   Department of Obstetrics and Gynecology, University of Mississippi at Jackson, Jackson, Mississippi
,
Sean Blackwell
10   Department of Obstetrics and Gynecology, University of Houston at Houston, Houston, Texas
,
Jeff M. Szychowski
2   Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama
,
William Andrews
2   Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama
,
Alan T. Tita
2   Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama
,
for the Cesarean Section Optimal Antibiotic Prophylaxis Trial Consortium › Author Affiliations
Funding This study received funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant no. HD64729).
Further Information

Publication History

29 November 2018

05 February 2019

Publication Date:
15 March 2019 (online)

Abstract

Objective Hospital readmissions are increasingly tracked and assessed for value-based compensation. Our objective was to determine the incidence and risk factors associated with post-cesarean delivery (CD) readmissions or unexpected visits, defined as unexpected office or emergency room visits.

Study Design This is a secondary analysis of a multicenter randomized controlled trial of adjunctive azithromycin prophylaxis for CD performed in laboring patients with viable pregnancies. Patients were followed up to 6 weeks postpartum. Our primary outcome was a composite of hospital readmission or unexpected visit, defined as unscheduled clinic or emergency department visits. Data of hospital readmissions, unexpected visits, and their reasons were collected. Demographics, antepartum, intrapartum, and postpartum risk factors were evaluated in bivariate analyses and multivariable logistic regression modeling.

Results A total of 1,019 women were randomized to azithromycin and 994 to placebo. The prevalence of readmission or unexpected visit was 10.2% (95% confidence interval [CI]: 8.9–11.6), with rates of 3.8% (95% CI: 3.0–4.7%) hospital readmissions, 6.9% (95% CI: 5.8–8.0%) emergency room visits, and 4.2% (95% CI: 3.4–5.2%) unexpected clinic visits. The most common causes were infectious disease and hypertensive disorder. Women with readmissions or unexpected visits were more likely to be obese and diabetic, as well as experience longer length of ruptured membranes, intrauterine pressure catheter placement, and postpartum fevers. On multivariable analysis, diabetes (adjusted odds ratio [aOR]: 1.6, 95% CI: 1.1–2.4), prolonged ruptured membranes (aOR: 1.9, 95% CI: 1.3–2.8), and postpartum fevers (aOR: 4.6, 95% CI: 3.0–7.0) were significantly positively associated with readmission or unscheduled visit, while azithromycin was a protective (aOR: 0.6, 95% CI: 0.5–0.9).

Conclusion Women who had postpartum fever were at especially high risk for readmission or unexpected visits. Diabetes, prolonged ruptured membranes, and postpartum fevers were significantly associated with the adverse outcome, and azithromycin was associated with lower rates of readmission and unexpected visits.

Condensation

In women delivered by unplanned cesarean, the incidence of readmission or unexpected visits was 10.2%. Women who develop fever during the postpartum period are at significantly high risk for readmission or unexpected visits.