ABSTRACT
BACKGROUND
Management of postpartum stroke has been the focus of several quality improvement
efforts in the past decade. However, there is little recent national trends data for
postpartum stroke readmissions.
OBJECTIVE
To determine trends, risk factors, and complications associated with postpartum stroke
readmission.
METHODS
The 2013-2019 Nationwide Readmissions Database was used to perform a retrospective
cohort study evaluating risk for readmission for stroke within 60 days of delivery
hospitalization discharge. Temporal trends in readmissions were analyzed using the
National Cancer Institute's Joinpoint Regression Program to estimate the average annual
percent change (AAPC) with 95% CIs. Stratified trends were analyzed for hemorrhage
stroke, ischemic stroke, and stroke readmissions 1-10, 11-30, and 31-60 days after
delivery discharge. Risk factors for stroke were analyzed with unadjusted and adjusted
logistic regression models with odds ratios (ORs) with 95% CIs as measures of association.
Risk for stroke complications was analyzed including mechanical ventilation, seizures,
death, and prolonged stay ≥14 days.
RESULTS
Of an estimated 21,754,603 delivery hospitalizations, 5,006 were complicated by a
60-day postpartum readmission with a diagnosis of stroke. The average annual percent
change for all stroke readmissions over the study period was not significant (AAPC
0.1%, 95% CI -2.2%, 2.4%). When trends in readmission for ischemic and hemorrhagic
stroke were analyzed, results were similar as were stratified analyses by readmission
timing. Risk factors associated with increased odds included superimposed preeclampsia
(OR 4.8, 95% CI 3.9, 5.9), preeclampsia with severe features (OR 3.7, 95% CI 3.0,
4.4), maternal cardiac disease (OR 3.0, 95% CI 2.5, 3.7), chronic kidney disease (OR
5.0, 95% CI 3.4, 7.5), and lupus (OR 7.0, 95% CI 4.9, 10.2). Risk was retained in
adjusted analyses. Common stroke-related complications included prolonged hospital
stay ≥14 days (12.1 per 1000 stroke-related readmissions), seizures (9.9 per 1000
stroke-related readmissions), and mechanical ventilation (6.6 per 1,000 stroke-related
readmissions).
CONCLUSION
This analysis of nationally representative data demonstrated no change in the rate
of 60-day postpartum hospitalizations with stroke from 2013 to 2019. Further clinical
research is indicated to optimize risk reduction for stroke after delivery hospitalization
discharge.
Keywords
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Article info
Publication history
Accepted:
January 10,
2023
Received in revised form:
January 5,
2023
Received:
October 31,
2022
Publication stage
In Press Accepted ManuscriptFootnotes
Conflict of interest Disclosure statement: Dr. D'Alton had a senior leadership role in ACOG II's Safe Motherhood Initiative which received unrestricted funding from Merck for Mothers. Dr. Wen serves as a consultant on the medical advisory board for Delfina, Inc. The other authors did not report any potential conflicts of interest.
FundingNone
IRB Given that this study involved a de-identified and publicly available dataset, the Institutional Review Board review at Columbia University and deemed this exempt from review.
Identification
Copyright
© 2023 Published by Elsevier Inc.
