(1163) Reducing Postpartum Readmissions: Development of a Risk Model Based on Maternal and Peripartum Factors

To identify maternal and peripartum risk factors for postpartum hospital readmission and to develop a clinically applicable risk score for early identification of high-risk patients.

Study Design:

This retrospective cohort study included 132,850 women who delivered at Sheba Medical Center between 2011 and 2023. Data were extracted from a perinatal database. Readmission was defined as re-hospitalization within 30 days postpartum. Maternal, obstetric, and neonatal characteristics were compared between patients readmitted and those not. Independent predictors were identified using multivariate logistic regression, and a risk score was developed based on regression coefficients.

Results:

Among 838 women (0.63%) readmitted postpartum, patients were older, had higher BMI, and more comorbidities such as chronic hypertension (7.2% vs. 1.1%), renal disease (4.3% vs. 1.3%), and pregestational diabetes (3.7% vs. 1.2%) (all p< 0.001). Cesarean delivery (78.0% vs. 29.1%), preeclampsia (17.4% vs. 4.6%), and preterm birth (32.1% vs. 11.4%) were significantly more common. Infections were the leading cause of readmission (51.2%), mainly surgical site infections and endometritis, followed by preeclampsia (15%), PPH (6%), and VTE (2.5%).

Subgroup analyses linked infection-related readmissions to postpartum fever. Preeclampsia-related cases were more common with chronic hypertension, obesity, and older maternal age. VTE-related readmissions were associated with placental abruption and fetal growth restriction.

Six independent predictors were identified: chronic hypertension, preeclampsia, preterm birth, cesarean/instrumental delivery, postpartum fever, LMWH use, and blood transfusion. The risk model stratified patients into low, moderate, and high-risk groups, with readmission probabilities from 0.16% to 69.6% (Fig. 1).

Conclusion:

Postpartum readmission is associated with comorbidities and peripartum complications. A simple risk score allows early identification of high-risk women and may facilitate a quality improvement intervention.