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Am J Perinatol
DOI: 10.1055/a-2097-1584
Original Article

Early Postpartum Hospital Encounters among Patients with Genitourinary and Wound Infections during Hospitalization for Birth

Stephanie A. Leonard 
1   Department of Obstetrics and Gynecology, Stanford University, Stanford, California
,
Anna I. Girsen
1   Department of Obstetrics and Gynecology, Stanford University, Stanford, California
,
Paula Trepman
1   Department of Obstetrics and Gynecology, Stanford University, Stanford, California
,
Suzan L. Carmichael
1   Department of Obstetrics and Gynecology, Stanford University, Stanford, California
2   Department of Pediatrics, Stanford University, Stanford, California
,
Kelly Darmawan
1   Department of Obstetrics and Gynecology, Stanford University, Stanford, California
,
Alexander J. Butwick
3   Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
,
Ronald S. Gibbs 
1   Department of Obstetrics and Gynecology, Stanford University, Stanford, California
› Author Affiliations Funding None.
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Abstract

Objectives This study aimed to assess the associations between genitourinary and wound infections during the birth hospitalization and early postpartum hospital encounters, and to evaluate clinical risk factors for early postpartum hospital encounters among patients with genitourinary and wound infections during the birth hospitalization.

Study Design We conducted a population-based cohort study of births in California during 2016 to 2018 and postpartum hospital encounters. We identified genitourinary and wound infections using diagnosis codes. Our main outcome was early postpartum hospital encounter, defined as a readmission or emergency department (ED) visit within 3 days after discharge from the birth hospitalization. We evaluated the association of genitourinary and wound infections (overall and subtypes) with early postpartum hospital encounter using logistic regression, adjusting for sociodemographic factors and comorbidities and stratified by mode of birth. We then evaluated factors associated with early postpartum hospital encounter among patients with genitourinary and wound infections.

Results Among 1,217,803 birth hospitalizations, 5.5% were complicated by genitourinary and wound infections. Genitourinary or wound infection was associated with an early postpartum hospital encounter among patients with both vaginal births (2.2%; adjusted risk ratio [aRR[: 1.26; 95% confidence interval [CI]: 1.17–1.36) and cesarean births (3.2%; aRR: 1.23; 95% CI: 1.15–1.32). Patients with a cesarean birth and a major puerperal infection or wound infection had the highest risk of an early postpartum hospital encounter (6.4 and 4.3%, respectively). Among patients with genitourinary and wound infections during the birth hospitalization, factors associated with an early postpartum hospital encounter included severe maternal morbidity, major mental health condition, prolonged postpartum hospital stay, and, among cesarean births, postpartum hemorrhage (p-value < 0.05).

Conclusion Genitourinary and wound infections during hospitalization for birth may increase risk of a readmission or ED visit within the first few days after discharge, particularly among patients who have a cesarean birth and a major puerperal infection or wound infection.

Key Points

  • In all, 5.5% of patients giving birth had a genitourinary or wound infection (GWI).

  • A total of 2.7% of GWI patients had a hospital encounter within 3 days of discharge after birth.

  • Major puerperal infection and wound infection had the highest risk of an early hospital encounter.

  • Among GWI patients, several birth complications were associated with an early hospital encounter.

Keywords

patient readmission - puerperal infection - wound infection - postpartum period - genitourinary - emergency department

Supplementary Material



Publication History

Received: 24 May 2022

Accepted: 19 May 2023

Accepted Manuscript online:
22 May 2023

Article published online:
19 June 2023

© 2023. Thieme. All rights reserved.

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