title: Risk of maternal postpartum readmission associated with mode of delivery.
abstract: OBJECTIVE
  To determine whether cesarean and operative vaginal deliveries are associated with an increased risk of maternal rehospitalization compared with spontaneous vaginal delivery.
  
  
  METHODS
  A population-based cohort study was conducted by using the Canadian Institute for Health Information's Discharge Abstract Database between 1997/1998 and 2000/2001, which included 900,108 women aged 15-44 years with singleton live births (after excluding several selected obstetric conditions).
  
  
  RESULTS
  A total of 16,404 women (1.8%) were rehospitalized within 60 days after initial discharge. Compared with spontaneous vaginal delivery (rate 1.5%), cesarean delivery was associated with a significantly increased risk of postpartum readmission (rate 2.7%, odds ratio [OR] 1.9, 95% confidence interval [CI] 1.8-1.9); ie, there was 1 excess postpartum readmission per 75 cesarean deliveries. Diagnoses associated with significantly increased risks of readmission after cesarean delivery (compared with spontaneous vaginal delivery) included pelvic injury/wounds (rate 0.86% versus 0.06%, OR 13.4, 95% CI 12.0-15.0), obstetric complications (rate 0.23% versus 0.08%, OR 3.0, 95% CI 2.6-3.5), venous disorders and thromboembolism (rate 0.07% versus 0.03%, OR 2.7, 95% CI 2.1-3.4), and major puerperal infection (rate 0.45% versus 0.27%, OR 1.8, 95% CI 1.6-1.9). Women delivered by forceps or vacuum were also at an increased risk of readmission (rates 2.2% and 1.8% versus 1.5%; OR forceps: 1.4, 95% CI 1.3-1.5; OR vacuum: 1.2, 95% CI 1.2-1.3, respectively). Higher readmission rates after operative vaginal delivery were due to pelvic injury/wounds, genitourinary conditions, obstetric complications, postpartum hemorrhage, and major puerperal infection.
  
  
  CONCLUSIONS
  Compared with spontaneous vaginal delivery, cesarean delivery, and operative vaginal delivery increase the risk of maternal postpartum readmission.
  
  
  METHODS
  II-2.
authors.affiliation: Health Surveillance and Epidemiology Division, Centre for Healthy Human Development, Public Health Agency of Canada, Ottawa, Ontario. Shiliang_Liu@hc-sc.gc.ca
authors.forename: Shiliang
authors.initials: S
authors.lastname: Liu
authors.forename: Maureen
authors.initials: M
authors.lastname: Heaman
authors.forename: K S
authors.initials: KS
authors.lastname: Joseph
authors.forename: Robert M
authors.initials: RM
authors.lastname: Liston
authors.forename: Ling
authors.initials: L
authors.lastname: Huang
authors.forename: Reg
authors.initials: R
authors.lastname: Sauve
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kramer
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data; D016208:Databases, Factual; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011247:Pregnancy; D011644:Puerperal Disorders / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors