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

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

Impact of COVID-19 on Perinatal Outcomes and Birth Locations in a Large US Metropolitan Area

“…This reduction may be the direct result of adaptations in discharge protocols to reduce the transmission of the virus and reduce the burden on hospital capacity and operations or may be the byproduct of inadvertent change to expedite the discharge process. This aligns with reports of decreased LOS specifically in low-risk and controlled delivery settings [34][35][36]. Few studies reported negative feelings and experiences of parents in the hospital setting during the pandemic, which could have affected LOS and expedited the discharge process, such as women not feeling safe giving birth, parents reporting themes of loneliness, emotional distress, adverse breastfeeding experiences, and unanticipated changes in hospital policies [37][38][39].…”

“…Fourth, we did not have access to readmission data to assess downstream medical risks due to LOS reductions. Although data from one New York hospital system suggest that the LOS reduction was not offset by an increase in maternal readmissions in the 30 days after delivery, more research is needed to examine the longerterm consequences and safety of these pandemic-induced birth changes [35]. Fifth, we focused on the PTB type of indicated vs. spontaneous with the hypothesis that the pandemic affected many aspects of prenatal care delivery.…”