Postpartum Length of Stay and Hospital Readmission Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic

医学 产科 大流行 怀孕 优势比 回顾性队列研究 阴道分娩 2019年冠状病毒病(COVID-19) 逻辑回归 置信区间 队列研究 疾病 传染病(医学专业) 内科学 生物 遗传学
作者
Sara C. Handley,Kieran Gallagher,Eric Lindgren,Justin Y. Lo,Heather H. Burris,Kevin Dysart,Jay S. Greenspan,Jennifer F. Culhane,Moeun Son
出处
期刊:Obstetrics & Gynecology [Ovid Technologies (Wolters Kluwer)]
被引量:22
标识
DOI:10.1097/aog.0000000000004687
摘要

OBJECTIVE: To compare postpartum hospitalization length of stay (LOS) and hospital readmission among obstetric patients before (March 2017–February 2020; prepandemic) and during the coronavirus disease 2019 (COVID-19) pandemic (March 2020–February 2021). METHODS: We conducted a retrospective cohort study, using Epic Systems' Cosmos research platform, of obstetric patients who delivered between March 1, 2017, and February 28, 2021, at 20–44 weeks of gestation and were discharged within 7 days of delivery. The primary outcome was short postpartum hospitalization LOS (less than two midnights for vaginal births and less than three midnights for cesarean births) and secondary outcome was hospital readmission within 6 weeks of postpartum hospitalization discharge. Analyses compared outcomes before and during the pandemic using standardized differences and Bayesian logistic mixed-effects models, among all births and stratified by mode of delivery. RESULTS: Of the 994,268 obstetric patients in the study cohort, 742,113 (74.6%) delivered prepandemic and 252,155 (25.4%) delivered during the COVID-19 pandemic. During the COVID-19 pandemic, the percentage of short postpartum hospitalizations increased among all births (28.7–44.5%), vaginal births (25.4–39.5%), and cesarean births (35.3–55.1%), which was consistent with the adjusted analysis (all births: adjusted odds ratio [aOR] 2.35, 99% credible interval 2.32–2.39; vaginal births: aOR 2.14, 99% credible interval 2.11–2.18; cesarean births aOR 2.90, 99% credible interval 2.83–2.98). Although short postpartum hospitalizations were more common during the COVID-19 pandemic, there was no change in readmission in the unadjusted (1.4% vs 1.6%, standardized difference=0.009) or adjusted (aOR 1.02, 99% credible interval 0.97–1.08) analyses for all births or when stratified by mode of delivery. CONCLUSION: Short postpartum hospitalization LOS was significantly more common during the COVID-19 pandemic for obstetric patients with no change in hospital readmissions within 6 weeks of postpartum hospitalization discharge. The COVID-19 pandemic created a natural experiment, suggesting shorter postpartum hospitalization may be reasonable for patients who are self-identified or health care professional–identified as appropriate for discharge.
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