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

Abstract

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 difference50.009) 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.

Pregnancy during a Pandemic: A Cohort Study Comparing Adverse Outcomes during and before the COVID-19 Pandemic

“…Additionally, this study did not measure the number of prenatal visits in either cohort due to the lack of uniformity in use of electronic medical record among prenatal providers. It has been reported that telehealth visits increased significantly during the pandemic, 44 thus further studies should evaluate whether possible changes in the quantity or type of prenatal visits may have contributed to adverse pregnancy outcomes during the pandemic. The impact of stress management and assessment during pregnancy may guide future tools and practice to improve pregnancy outcomes.…”

Postpartum readmissions for hypertensive disorders in pregnancy during the COVID-19 pandemic

“… 11 , 12 This is consistent with other studies evaluating labor and delivery policy modifications due to COVID-19 that did not demonstrate an increase in adverse maternal postpartum outcomes with shorter postpartum lengths of stay in the overall obstetric population. 13 , 14 , 15 Although there was not an overall difference in the LOS between groups during the delivery admission, our institution was able to safely implement an early discharge policy that did not increase the rate of postpartum readmission due to HDP or increase postpartum adverse outcomes such as postpartum eclampsia, stroke or death among the study cohort. As our institution's baseline cesarean delivery rate was similar between groups, there was a higher rate of cesarean deliveries in the COVID group that could potentially influence the lack of difference in the LOS amongst groups.…”

Association Between Giving Birth During the Early Coronavirus Disease 2019 (COVID-19) Pandemic and Serious Maternal Morbidity

“…The association between giving birth during the COVID-19 pandemic and shorter hospital stays has been observed in other studies. 14 We followed patients through 42 days postpartum, so any increased risk for mortality or serious morbidity associated with these shorter hospital stays would have been identified.…”