Measuring severe maternal morbidity should include the postpartum period up to 42 days, as it captures a 32% increase in events, most commonly sepsis.
Objective. Severe maternal morbidity (SMM) is a growing public health concern in the United States. While existing measures capture SMM-related complications during the delivery hospitalization, patients may also experience serious complications after discharge that affect long-term health, mortality, and health care utilization. We aimed to assess the frequency of SMM events occurring after hospital discharge and identify the appropriate post-discharge window for measurement. Study Design. We analyzed 2019-2021 delivery hospitalizations among women aged 12-55 years using the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) from 17 states, with follow-up through 2021. SMM was identified per AHRQ measure specifications in inpatient and emergency department (ED) encounters. We calculated overall SMM rates, as well as specific SMM-related complications, during delivery hospitalization and after discharge. Results. The SMM rate during delivery hospitalization was 87.1 per 10,000 deliveries. Extending the measurement period through 42 days post-discharge increased the cumulative SMM rate by 32% to 115.0 per 10,000 deliveries. More than 80% of SMM events observed within 90 days occurred in the first 42 days after discharge, and 97.5% of these were treated in inpatient settings. Coagulopathy (26.0 per 10,000), acute renal failure (21.4 per 10,000), and sepsis (25.3 per 10,000) had the highest cumulative rates through 42 days post-discharge. Coagulopathy was the most common complication during the delivery hospitalization (27.7%), whereas sepsis emerged as the most frequent condition treated after discharge (34.4%). Conclusion. Our study highlights the importance of including the postpartum period when measuring SMM. Most events were treated in an inpatient setting, and the majority occurred within 42 days after delivery. To address SMM, research and policy warrants focus on maternal health during and after the delivery hospitalization.
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