Inpatient mortality and postpartum readmission rates in sickle cell disease pregnancies: a multistate analysis, 2007-2014

Objective We compared post-partum outcomes between sickle cell disease (SCD) and non-sickle cell populations. Methods We conducted a retrospective analysis of discharge data for 6,911,916 inpatient deliveries in the states of California, Florida, New York, Maryland, and Kentucky from 2007 to 2014 using data from the State Inpatient Databases, Healthcare Cost and Utilization Project. We compared unadjusted rates and adjusted odds of 30- and 90-d readmission rates, in-hospital mortality, length of stay (LOS), and total hospital charges in SCD, sickle cell trait, and non-sickle cell patients. Results Compared to non-sickle cell patients, SCD patients were more than two times as likely to die in-hospital (aOR: 2.16, 95% CI: 1.15-4.04, p<.05), 27% as likely to be readmitted up to 30d postdelivery (aOR: 1.27, 95% CI: 1.13-1.43, p<.001), and 92% as likely to be readmitted up to 90d postdelivery (aOR 1.92, 95% CI: 1.75-2.11, p<.001). The SCD group also had a longer median LOS, greater total hospital charges, were more likely to experience a postpartum complication, and receive a blood transfusion than the non-SCD group. Conclusions SCD in pregnancy is associated with increased inpatient mortality, readmissions, postpartum complications, LOS, and hospital charges.

Automated summary

Compared to non-sickle cell patients, SCD patients have higher inpatient mortality rates, lower 30-day readmission rates, higher 90-day readmission rates, longer length of stay, higher hospital charges, and higher likelihood of experiencing postpartum complications.