Acute postpartum care utilization after expedited postpartum discharge

ABSTRACT

Objective: During the COVID-19 pandemic, many hospitals provided expedited postpartum discharge (EPD) for patients wishing to leave the hospital soon after birth. This study was performed to assess whether acute postpartum care utilization increased after EPD during COVID-19. Study Design: Birth hospitalization data from a single teaching hospital from two 6-week periods (3/22-4/30/19 and 3/22-4/30/20) were used for this retrospective cohort study. EPD, defined as discharge on postpartum day 1 or 2 following vaginal or cesarean birth, respectively, was the primary exposure. The primary outcome was acute postpartum care utilization defined as emergency or obstetrical triage unit visits within 6 weeks of delivery. Secondary outcomes included 6-week postpartum readmission. We fit logistic regression models to assess the risk for the primary and secondary outcomes. Categorical comparisons were made with the chi square test. Results: Of 1,358 deliveries in the study, 5.0% of deliveries in 2019 (n=36) compared to 60.3% of deliveries in 2020 (n=388) underwent EPD (p< 0.01). Rates of acute postpartum care utilization were 8.8% and 5.6% for 2019 and 2020, respectively (Figure 1). In 2020, patients with hypertensive disorders of pregnancy (HDP), chorioamnionitis/endometritis, or a positive COVID test were less likely to be discharged early (Table 1). There were no significant differences in rates of acute postpartum care utilization (OR 0.9, 95% CI 0.5, 1.8) or readmissions (OR 1.3, 95% CI 0.5, 3.6) between patients with EPD as compared to routine discharge. Among patients with HDP, readmission risk was significantly higher among those who had early discharge as compared to routine discharge (OR 6.1, 95% CI 2.1, 17.3). Conclusion: Rates of EPD were significantly higher in 2020 compared to 2019 with no impact on acute postpartum care utilization or readmission rates. Among patients with hypertensive disorders of pregnancy, expedited discharge was associated with higher risk of readmission. EPD discharge does not appear to be associated with increased acute postpartum care utilization among low-risk patients. [Formula presented] [Formula presented]