Too G, et al. - The researchers performed this study to identify risk and timing of postpartum stroke readmission after delivery hospitalization discharge. Patients with chronic hypertension and hypertensive diseases of pregnancy were at higher risk of postpartum stroke. However, they accounted for a minority of such strokes. The majority of readmissions for postpartum stroke occurred within 10 days of discharge. During this period, optimal blood pressure management could be particularly important.

Methods

• The researchers used the Healthcare Cost and Utilization Project's Nationwide Readmissions Database for calendar years 2013 and 2014 to conduct a retrospective cohort study evaluating risk of readmission for stroke within 60 days of discharge from a delivery hospitalization.
• They characterized risk as odds ratios (ORs) with 95% CIs based on whether patients had hypertensive diseases of pregnancy (gestational hypertension or preeclampsia), or chronic hypertension, or neither disorder during the index hospitalization.
• They created adjusted models for stroke readmission risk.

Results

• A total of 6,272,136 delivery hospitalizations were included in the analysis from January 1, 2013, to October 31, 2013, and January 1, 2014, to October 31, 2014.
• The researchers identified 1,505 cases of readmission for postpartum stroke.
• In this study, 214 (14.2%) cases of stroke occurred among patients with hypertensive diseases of pregnancy, 66 (4.4%) with chronic hypertension, and 1,225 (81.4%) without hypertension.
• Within 10 days of hospital discharge, the majority of stroke readmissions occurred (58.4%), including 53.2% of patients with hypertensive diseases of pregnancy during the index hospitalization, 66.7% with chronic hypertension, and 58.9% with no hypertension.
• An association of hypertensive diseases of pregnancy and chronic hypertension was observed with an increased risk of stroke readmission compared with no hypertension (OR 1.74, 95% CI 1.33-2.27 and OR 1.88, 95% CI 1.19-2.96, respectively).
• For hypertensive diseases of pregnancy, median times to readmission were 8.9 days, for chronic hypertension, it was noted to be 7.8 days, and it was 8.3 days without either condition.