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Risk Factors for Postpartum Emergency Department Visits in an Urban Population

  • Jean-Ju SheenEmail author
  • Heather A. Smith
  • Brian Tu
  • Ying Liu
  • Desmond Sutton
  • Peter S. Bernstein
Article

Abstract

Objectives To identify risk factors associated with urban postpartum emergency department utilization. Methods This case–control study included 100 matched pairs of postpartum women who had delivered at a large, integrated urban medical system in Bronx, New York, in 2012–2013, with the cases having had an emergency department visit within 42 days of delivery. The cases, identified utilizing administrative and billing data, were matched 1:1 with controls by labor unit, delivery mode and date, excluding nonviable pregnancies. The controls did not have a known postpartum emergency department visit. Variables were abstracted from administrative data and chart review, and included demographics, antenatal/intrapartum/postpartum complications and neonatal intensive care unit admission. Factors associated with puerperal emergency department use were identified via univariate and multivariable analyses. Results Following conditional logistic regression, primiparity [54% vs. 32%, aOR 5.91, 95% CI 2.34–14.91], public insurance [70% vs. 56%, aOR 4.22, 95% CI 1.60–11.12], weekend delivery [30% vs. 26%, aOR 7.61, 95% CI 1.15–52.43] and delivery-related complications [47% vs. 28%, aOR 2.95, 95% CI 1.16–7.51] were associated with an increased risk of postpartum emergency department use, while women of younger ages (17–24 years old) were less likely to have postpartum emergency department use [aOR 0.23, 95% CI 0.07–0.74]. Univariate analysis of individual events within the composite variables showed an association between gestational hypertension/pre-eclampsia and postpartum emergency department use [28% vs. 13% OR 2.60, 95% CI 1.26–5.39]. Psychiatric history, social instability, preterm delivery/neonatal intensive care unit admission, pre-existing medical/antepartum conditions and prolonged postpartum stay were not associated. Conclusions for Practice Delivery-related complications, delivery timing, and certain sociodemographic factors are identifiable risk factors for increased postpartum emergency department utilization. These may be targeted for development of interventions improving puerperal care and potentially preventing emergency department visits, which are costly to the health system and disruptive to the lives of women and their families.

Keywords

Maternal morbidity Postpartum emergency department use Postpartum period Risk factors for postpartum emergency department use 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics & Gynecology and Women’s HealthMontefiore Medical Center, Albert Einstein College of MedicineBronxUSA
  2. 2.Department of Obstetrics and GynecologyColumbia University Irving Medical CenterNew YorkUSA
  3. 3.Department of Obstetrics and Gynecology, Women and Infants HospitalBrown UniversityProvidenceUSA
  4. 4.Department of Obstetrics and GynecologySkagit Valley HospitalMount VernonUSA

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