Risk of Maternal Postpartum Readmission Associated With Mode of Delivery

TLDR

The study aimed to assess whether cesarean and operative vaginal deliveries elevate the risk of maternal readmission within 60 days compared with spontaneous vaginal delivery. Using a population‑based cohort from the Canadian Institute for Health Information's Discharge Abstract Database (1997/1998–2000/2001), 900,108 women aged 15–44 with singleton live births were followed, and 16,404 (1.8%) were rehospitalized. Cesarean delivery was associated with a 1.9‑fold higher readmission risk (2.7% vs 1.5%, one excess readmission per 75 cesareans), and operative vaginal delivery also increased risk (2.2%–1.8% vs 1.5%, ORs 1.4 and 1.2); elevated risks were driven by pelvic injury, obstetric complications, venous disorders, and puerperal infection.

Abstract

To determine whether cesarean and operative vaginal deliveries are associated with an increased risk of maternal rehospitalization compared with spontaneous vaginal delivery.A population-based cohort study was conducted by using the Canadian Institute for Health Information's Discharge Abstract Database between 1997/1998 and 2000/2001, which included 900,108 women aged 15-44 years with singleton live births (after excluding several selected obstetric conditions).A total of 16,404 women (1.8%) were rehospitalized within 60 days after initial discharge. Compared with spontaneous vaginal delivery (rate 1.5%), cesarean delivery was associated with a significantly increased risk of postpartum readmission (rate 2.7%, odds ratio [OR] 1.9, 95% confidence interval [CI] 1.8-1.9); ie, there was 1 excess postpartum readmission per 75 cesarean deliveries. Diagnoses associated with significantly increased risks of readmission after cesarean delivery (compared with spontaneous vaginal delivery) included pelvic injury/wounds (rate 0.86% versus 0.06%, OR 13.4, 95% CI 12.0-15.0), obstetric complications (rate 0.23% versus 0.08%, OR 3.0, 95% CI 2.6-3.5), venous disorders and thromboembolism (rate 0.07% versus 0.03%, OR 2.7, 95% CI 2.1-3.4), and major puerperal infection (rate 0.45% versus 0.27%, OR 1.8, 95% CI 1.6-1.9). Women delivered by forceps or vacuum were also at an increased risk of readmission (rates 2.2% and 1.8% versus 1.5%; OR forceps: 1.4, 95% CI 1.3-1.5; OR vacuum: 1.2, 95% CI 1.2-1.3, respectively). Higher readmission rates after operative vaginal delivery were due to pelvic injury/wounds, genitourinary conditions, obstetric complications, postpartum hemorrhage, and major puerperal infection.Compared with spontaneous vaginal delivery, cesarean delivery, and operative vaginal delivery increase the risk of maternal postpartum readmission.II-2.