n525,649). Multivariable logistic regression models were used to investigate the association of race and ethnicity on major and minor postoperative complications and reoperation.RESULTS: Racial minority groups were compared to non-Hispanic White people and adjusted for confounders. The NHPI patients had the highest risk of complication, at 4.6% greater risk of any postoperative complication (adjusted odds ratio [AOR] 1.046 [1.001-1.093]) and 3.2% greater risk of major complication (AOR 1.032 [1.006-1.058]). This was compared to a 3.2%, 1.9%, and 1.8% greater risk for any postoperative complication in Asian, Black, and Hispanic/ Latina patients, respectively. The AIAN patients had the highest risk of reoperation of all groups, at 2.6% greater risk of reoperation (AOR 1.026 [1.015-1.037]). CONCLUSION: Across all groups undergoing CD, NHPI patients had the greatest risk of any postoperative complication, and AIAN patients had the greatest risk of reoperation. Our findings emphasize the need to further investigate these underrepresented minority groups in future obstetric research.
OBJECTIVE:
To evaluate the effect of a postpartum hypertension standardized clinical assessment and management plan on postpartum readmissions and emergency department (ED) visits.
METHODS:
We conducted a prospective cohort study of patients with postpartum hypertension (either chronic hypertension or hypertensive disorders of pregnancy) who delivered at a single tertiary care center for 6 months after enacting an institution-wide standardized clinical assessment and management plan (postintervention group). Patients in the postintervention group were compared with patients in a historical control group. The standardized clinical assessment and management plan included 1) initiation or uptitration of medication for any blood pressure (BP) higher than 150/100 mm Hg or any two BPs higher than 140/90 mm Hg within a 24-hour period, with the goal of achieving normotension (BP lower than 140/90 mm Hg) in the 12 hours before discharge; and 2) enrollment in a remote BP monitoring system on discharge. The primary outcome was postpartum readmission or ED visit for hypertension. Multivariable logistic regression was used to evaluate the association between standardized clinical assessment and management plan and the selected outcomes. A sensitivity analysis was performed with propensity score weighting. A planned subanalysis in the postintervention cohort identified risk factors associated with requiring antihypertensive uptitration after discharge. For all analyses, the level of statistical significance was set at P<.05.
RESULTS:
Overall, 390 patients in the postintervention cohort were compared with 390 patients in a historical control group. Baseline demographics were similar between groups with the exception of lower prevalence of chronic hypertension in the postintervention cohort (23.1% vs 32.1%, P=.005). The primary outcome occurred in 2.8% of patients in the postintervention group and in 11.0% of patients in the historical control group (adjusted odds ratio [aOR] 0.24, 95% CI 0.12–0.49, P<.001). A matched propensity score analysis controlling for chronic hypertension similarly demonstrated a significant reduction in the incidence of the primary outcome. Of the 255 patients (65.4%) who were compliant with outpatient remote BP monitoring, 53 (20.8%) had medication adjustments made per protocol at a median of 6 days (interquartile range 5–8 days) from delivery. Non-Hispanic Black race (aOR 3.42, 95% CI 1.68–6.97), chronic hypertension (aOR 2.09, 95% CI 1.13–3.89), having private insurance (aOR 3.04, 95% CI 1.06–8.72), and discharge on antihypertensive medications (aOR 2.39, 95% CI 1.33–4.30) were associated with requiring outpatient adjustments.
CONCLUSION:
A standardized clinical assessment and management plan significantly reduced postpartum readmissions and ED visits for patients with hypertension. Close outpatient follow-up to ensure appropriate medication titration after discharge may be especially important in groups at high risk for readmission.
Glass shard data in CaO wt% are from Schindlbeck et al. (2018a). Filled red: Izu Bonin glass shards; open red: Japan glass shards; Thin black lines -discrete tephra fallout layers. Solid blue lines -discrete tephra fallout ash bed (either layer or pod) of Japan origin, numbers indicating widespread marker layers; broken blue lines -glass shards of Japan origin mixed with Izu Bonin glass shards.Grey/white bars -interglacial/glacial periods, after Lisieki and Raymo (2005). DD -original bedding destroyed by drilling disturbance. Right side -MIS marine isotope stages; Horizontal bar, calculated for every 10 ka, illustrates the variations in sedimentation rate. Oxygen isotope stratigraphy (Mleneck-Vautravers, 2018) ends at 980 ka, causing a small artificial gap at the transition to the linear sedimentation rate (Tamura et al., 2015).
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