Uncaptured rates of postpartum venous thromboembolism: a US national analysis.

Abstract

To quantify the proportion of postpartum venous thromboembolism (VTE) readmissions, including those that occur at different hospitals from index admission, and describe risk factors for this outcome. Retrospective observational study. US hospitals included in the Nationwide Readmissions Database. A total of 3 719 238 patients >14 years of age with a delivery-associated hospitalisation in 2014. Univariate analysis was performed to identify patient and hospital factors associated with readmissions. Significant factors were included in multivariate logistic regression to identify independent risk factors. Results were weighted for national estimates. Readmission with VTE to both index and different hospitals at 30, 60 and 90 days. The VTE cumulative readmission rate was 0.053% (n = 1477), 0.063% (n = 1765) and 0.069% (n = 1938) at 30, 60 and 90 days, respectively. Patients were readmitted to different hospitals 31% of the time within 90 days. Risk factors for different hospital VTE readmission were unique and included younger age and initial admission to a small/medium-sized hospital. Initial admission to a for-profit hospital increased the likelihood of readmission to a different hospital. Nearly one in three postpartum VTEs are missed by the current quality metrics, with significant implications for outcomes and quality. For-profit hospitals have a significant portion of their VTE readmissions hidden, falsely lowering their readmission rates relative to public hospitals. US analysis shows 1 in 3 readmissions for postpartum venous thromboembolism currently missed.