Wen T, et al. - Researchers focused on the risk factors for and timing of postpartum venous thromboembolism (VTE) readmission after delivery hospitalization discharge. They reported the occurrence of the majority of events within 20 days of discharge. A general association of risk factors other than thrombophilia and prior VTE, with modestly increased odds of events was observed. Among women with thrombophilias and prior events, the occurrence of only a small proportion of readmissions was documented.

Methods

• In this retrospective cohort study, researchers used the Healthcare Cost and Utilization Project’s Nationwide Readmissions Database for calendar years 2013 and 2014, to assess the risk for readmission for venous thromboembolism within 60 days of discharge from a delivery hospitalization.
• Individual evaluation of risks for deep vein thrombosis (DVT) and pulmonary embolism (PE) was carried out.
• Analysis was performed of obstetric, medical, demographic, and hospital factors related to postpartum readmission for VTE.
• Risk was characterized as odds ratios (OR) with 95% confidence intervals (CI) and both unadjusted and adjusted analyses were carried out.
• Adjusted analyses were performed, including relevant obstetric, medical, demographic, and hospital factors within logistic regression models.

Results

• Overall, 6,269,641 delivery hospitalizations were included from January 1 to October 31, 2013 and 2014.
• They documented 2975 cases of readmission for any VTE (4.7 per 10,000 delivery hospitalizations) including 1170 cases of DVT and 1805 cases of PE.
• With regard to the occurrence of readmissions for any VTE, 69.6% were reported within the first 20 days of discharge vs 22.3% and 8.0% 21-40 and 41-60 days after discharge.
• As per data, the median times to readmission were 12.7, 14.0, and 11.7 days for VTE, DVT, and PE respectively.
• The following features were more likely to be seen among women readmitted for any VTE: to have a history of VTE (4.2% vs 0.3%, p<0.01), to have had a cesarean delivery (54.4% vs 32.4%, p<0.01), to have a thrombophilia (1.8% vs 0.4%, p<0.01), to have had a longer delivery hospitalization of >3 days for vaginal delivery and >4 days for cesarean (18.0% vs 6.6%, p<0.01), to have been diagnosed with gestational hypertension or preeclampsia (19.7% vs 8.2%, p<0.01), and to have had postpartum hemorrhage with transfusion (2.6% vs 0.5%, p<0.01).
• In adjusted models, these factors continued to be significant.
• In relation to history of VTE and hemorrhage with transfusion, the largest odds of readmission were reported (OR 9.5, 95% CI 6.6-13.6 and OR 3.6, 95% CI 2.4-5.5, respectively).
• Thrombophilia (OR 2.0, 95% CI 1.2-3.5), cesarean delivery (OR 2.0, 95% 1.8-2.3), longer delivery hospitalization (OR 1.8, 95% 1.5-2.2), and preeclampsia or gestational hypertension (OR 2.0, 95% CI 1.6-2.4) were identified as other factors that showed association with increased odds .