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Am J Perinatol 2022; 39(04): 354-360
DOI: 10.1055/s-0041-1740061
SMFM Fellowship Series Article

The Risk of Readmission after Early Postpartum Discharge during the COVID-19 Pandemic

Moti Gulersen 
1   Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
,
Gregg Husk
2   Department of Medical Informatics, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
,
Erez Lenchner
3   Department of Biostatistics and Data Management, NYU Rory Meyers College of Nursing, New York, New York
,
Matthew J. Blitz 
4   Department of Obstetrics and Gynecology, Southside Hospital, Zucker School of Medicine at Hofstra/Northwell, Bay Shore, New York
,
Timothy J. Rafael
1   Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
,
Burton Rochelson
1   Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
,
Shruti Chakravarthy
3   Department of Biostatistics and Data Management, NYU Rory Meyers College of Nursing, New York, New York
5   Department of Obstetrics and Gynecology, Staten Island University Hospital, Zucker School of Medicine at Hofstra/Northwell, Staten Island, New York
,
Amos Grunebaum
6   Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
,
Frank A. Chervenak
6   Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
,
Gary Fruhman
3   Department of Biostatistics and Data Management, NYU Rory Meyers College of Nursing, New York, New York
5   Department of Obstetrics and Gynecology, Staten Island University Hospital, Zucker School of Medicine at Hofstra/Northwell, Staten Island, New York
,
Monique De Four Jones
7   Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Queens, New York
,
Benjamin Schwartz
4   Department of Obstetrics and Gynecology, Southside Hospital, Zucker School of Medicine at Hofstra/Northwell, Bay Shore, New York
,
Michael Nimaroff
1   Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
,
Eran Bornstein
6   Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
› Author Affiliations Funding None.
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Abstract

Objective To determine whether early postpartum discharge during the coronavirus disease 2019 (COVID-19) pandemic was associated with a change in the odds of maternal postpartum readmissions.

Study Design This is a retrospective analysis of uncomplicated postpartum low-risk women in seven obstetrical units within a large New York health system. We compared the rate of postpartum readmissions within 6 weeks of delivery between two groups: low-risk women who had early postpartum discharge as part of our protocol during the COVID-19 pandemic (April 1–June 15, 2020) and similar low-risk patients with routine postpartum discharge from the same study centers 1 year prior. Statistical analysis included the use of Wilcoxon's rank-sum and chi-squared tests, Nelson–Aalen cumulative hazard curves, and multivariate logistic regression.

Results Of the 8,206 patients included, 4,038 (49.2%) were patients who had early postpartum discharge during the COVID-19 pandemic and 4,168 (50.8%) were patients with routine postpartum discharge prior to the COVID-19 pandemic. The rates of postpartum readmissions after vaginal delivery (1.0 vs. 0.9%; adjusted odds ratio [OR]: 0.75, 95% confidence interval [CI]: 0.39–1.45) and cesarean delivery (1.5 vs. 1.9%; adjusted OR: 0.65, 95% CI: 0.29–1.45) were similar between the two groups. Demographic risk factors for postpartum readmission included Medicaid insurance and obesity.

Conclusion Early postpartum discharge during the COVID-19 pandemic was associated with no change in the odds of maternal postpartum readmissions after low-risk vaginal or cesarean deliveries. Early postpartum discharge for low-risk patients to shorten hospital length of stay should be considered in the face of public health crises.

Key Points

  • Early postpartum discharge was not associated with an increase in odds of hospital readmissions after vaginal delivery.

  • Early postpartum discharge was not associated with an increase in odds of hospital readmissions after cesarean delivery.

  • Early postpartum discharge for low-risk patients should be considered during a public health crisis.

Keywords

SARS-CoV-2 - coronavirus - pregnancy - early discharge - postpartum discharge - postpartum readmission - pandemic


Publication History

Received: 16 October 2020

Accepted: 04 October 2021

Article published online:
10 December 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Fauci AS, Lane HC, Redfield RR. COVID-19 - navigating the uncharted. N Engl J Med 2020; 382 (13) 1268-1269
    CrossrefPubMedGoogle Scholar
  • 2 Rosenbaum L. Facing COVID-19 in Italy - ethics, logistics, and therapeutics on the epidemic's front line. N Engl J Med 2020; 382 (20) 1873-1875
    CrossrefPubMedGoogle Scholar
  • 3 Hunter DJ. COVID-19 and the stiff upper lip - the pandemic response in the United Kingdom. N Engl J Med 2020; 382 (16) e31
    CrossrefPubMedGoogle Scholar
  • 4 Truog RD, Mitchell C, Daley GQ. The toughest triage - allocating ventilators in a pandemic. N Engl J Med 2020; 382 (21) 1973-1975
    CrossrefPubMedGoogle Scholar
  • 5 Emanuel EJ, Persad G, Upshur R. et al. Fair allocation of scarce medical resources in the time of COVID-19. N Engl J Med 2020; 382 (21) 2049-2055
    CrossrefPubMedGoogle Scholar
  • 6 Hick JL, Biddinger PD. Novel coronavirus and old lessons - preparing the health system for the pandemic. N Engl J Med 2020; 382 (20) e55
    CrossrefPubMedGoogle Scholar
  • 7 Li R, Rivers C, Tan Q, Murray MB, Toner E, Lipsitch M. Estimated demand for US hospital inpatient and intensive care unit beds for patients with COVID-19 based on comparisons with Wuhan and Guangzhou, China. JAMA Netw Open 2020; 3 (05) e208297
    CrossrefPubMedGoogle Scholar
  • 8 Jamieson DJ, Steinberg JP, Martinello RA, Perl TM, Rasmussen SA. Obstetricians on the coronavirus disease 2019 (COVID-19) front lines and the confusing world of personal protective equipment. Obstet Gynecol 2020; 135 (06) 1257-1263
    CrossrefPubMedGoogle Scholar
  • 9 The New York Times. New York City region is now an epicenter of the coronavirus pandemic. Available at: https://www.nytimes.com/2020/03/22/nyregion/Coronavirus-new-York-epicenter.html. Retrieved July 10, 2020
    PubMedGoogle Scholar
  • 10 Tekbali A, Grünebaum A, Saraya A, McCullough L, Bornstein E, Chervenak FA. Pregnant vs nonpregnant severe acute respiratory syndrome coronavirus 2 and coronavirus disease 2019 hospital admissions: the first 4 weeks in New York. Am J Obstet Gynecol 2020; 223 (01) 126-127
    CrossrefPubMedGoogle Scholar
  • 11 Chervenak FA, Grünebaum A, Bornstein E. et al. Expanding the concept of the professional integrity of obstetrics during a public health emergency. J Perinat Med 2020; 48 (05) 435-437
    CrossrefPubMedGoogle Scholar
  • 12 Rochelson B, Nimaroff M, Combs A. et al. The care of pregnant women during the COVID-19 pandemic - response of a large health system in metropolitan New York. J Perinat Med 2020; 48 (05) 453-461
    CrossrefPubMedGoogle Scholar
  • 13 Bornstein E, Gulersen M, Husk G. et al. Early postpartum discharge during the COVID-19 pandemic. J Perinat Med 2020; 48 (09) 1008-1012
    CrossrefPubMedGoogle Scholar
  • 14 Fink AM. Early hospital discharge in maternal and newborn care. J Obstet Gynecol Neonatal Nurs 2011; 40 (02) 149-156
    CrossrefPubMedGoogle Scholar
  • 15 Brooten D, Roncoli M, Finkler S, Arnold L, Cohen A, Mennuti M. A randomized trial of early hospital discharge and home follow-up of women having cesarean birth. Obstet Gynecol 1994; 84 (05) 832-838
    PubMedGoogle Scholar
  • 16 Strong Jr TH, Brown Jr WL, Brown WL, Curry CM. Experience with early postcesarean hospital dismissal. Am J Obstet Gynecol 1993; 169 (01) 116-119
    CrossrefPubMedGoogle Scholar
  • 17 Brooten D, Kumar S, Brown LP. et al. A randomized clinical trial of early hospital discharge and home follow-up of very-low-birth-weight infants. N Engl J Med 1986; 315 (15) 934-939
    CrossrefPubMedGoogle Scholar
  • 18 Benahmed N, San Miguel L, Devos C, Fairon N, Christiaens W. Vaginal delivery: how does early hospital discharge affect mother and child outcomes? A systematic literature review. BMC Pregnancy Childbirth 2017; 17 (01) 289
    CrossrefPubMedGoogle Scholar
  • 19 Brown S, Small R, Faber B, Krastev A, Davis P. Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database Syst Rev 2002; (03) CD002958
    PubMedGoogle Scholar
  • 20 Sainz Bueno JA, Romano MR, Teruel RG. et al. Early discharge from obstetrics-pediatrics at the Hospital de Valme, with domiciliary follow-up. Am J Obstet Gynecol 2005; 193 (3 Pt 1): 714-726
    CrossrefPubMedGoogle Scholar
  • 21 Kehila M, Magdoud K, Touhami O. et al. [Early postpartum discharge: outcomes and risk factors of readmission]. Pan Afr Med J 2016; 24: 189
    CrossrefPubMedGoogle Scholar
  • 22 Brumfield CG. Early postpartum discharge. Clin Obstet Gynecol 1998; 41 (03) 611-625
    CrossrefPubMedGoogle Scholar
  • 23 Grullon KE, Grimes DA. The safety of early postpartum discharge: a review and critique. Obstet Gynecol 1997; 90 (05) 860-865
    CrossrefPubMedGoogle Scholar
  • 24 Clapp MA, Little SE, Zheng J, Robinson JN. A multi-state analysis of postpartum readmissions in the United States. Am J Obstet Gynecol 2016; 215 (01) 113.e1-113.e10
    CrossrefPubMedGoogle Scholar
  • 25 Johansson K, Aarts C, Darj E. First-time parents' experiences of home-based postnatal care in Sweden. Ups J Med Sci 2010; 115 (02) 131-137
    CrossrefPubMedGoogle Scholar
  • 26 Bostanci Ergen E, Ozkaya E, Eser A. et al. Comparison of readmission rates between groups with early versus late discharge after vaginal or cesarean delivery: a retrospective analyzes of 14,460 cases. J Matern Fetal Neonatal Med 2018; 31 (10) 1318-1322
    CrossrefPubMedGoogle Scholar
  • 27 Patel S, Rodriguez AN, Macias DA, Morgan J, Kraus A, Spong CY. A gap in care? Postpartum women presenting to the emergency room and getting readmitted. Am J Perinatol 2020; 37 (14) 1385-1392
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Wen T, Overton EE, Sheen JJ. et al. Risk of postpartum readmissions and associated complications based on maternal age. J Matern Fetal Neonatal Med 2021; 34 (09) 1375-1381
    CrossrefPubMedGoogle Scholar
  • 29 Batra P, Fridman M, Leng M, Gregory KD. Emergency department care in the postpartum period: California births, 2009-2011. Obstet Gynecol 2017; 130 (05) 1073-1081
    CrossrefPubMedGoogle Scholar
  • 30 Sheen JJ, Smith HA, Tu B, Liu Y, Sutton D, Bernstein PS. Risk factors for postpartum emergency department visits in an urban population. Matern Child Health J 2019; 23 (04) 557-566
    CrossrefPubMedGoogle Scholar
  • 31 Hartnett KP, Kite-Powell A, DeVies J. et al; National Syndromic Surveillance Program Community of Practice. Impact of the COVID-19 pandemic on emergency department visits - United States, January 1, 2019-May 30, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (23) 699-704
    CrossrefPubMedGoogle Scholar