Trends in postpartum stroke and risk for associated adverse outcomes

To determine trends, risk factors, and complications associated with postpartum stroke. The Healthcare Cost and Utilization Project’s Nationwide Readmissions Database for calendar years 2013 through 2019 was used to perform a retrospective cohort study evaluating risk for readmission for stroke within 60 days of discharge from a delivery hospitalization. Temporal trends in stroke during delivery hospitalizations were determined using the National Cancer Institute’s Joinpoint Regression Program to estimate the average annual percent change with 95% confidence intervals (CIs). Sensitivity trends were analyzed for hemorrhage stroke, ischemic stroke, and stroke readmissions 1-10, 11-30, and 31-60 days after delivery discharge. Risk factors for stroke were analyzed with adjusted logistic regression models with adjusted odds ratios (aORs) with 95% CIs as measures of association. From 2013 to 2019, 21,754,605 hospitalizations were included in the analysis, and 5,005 (0.023%) patients had a stroke in the postpartum period. The rate of postpartum stroke did not change (23.1 per 100,000 hospitalizations in 2013 vs 24.0 per 100,000 hospitalizations in 2019; p = 0.79). There was no significant change in rate during defined time frames—1-10 days, 11-30 days, and 31-60 days—after delivery discharge (0.014% in 2013 to 0.014% in 2019, 0.0058% in 2013 to 0.0063% in 2019, 0.0033% in 2013 to 0.0032% in 2019, respectively). Hypertensive disease of pregnancy and chronic hypertensive disease were associated with increased risk of stroke readmission compared to no hypertension (OR 2.24, 95% CI 2.01-2.49, OR 2.4, 95% CI 1.94-2.96, respectively). Postpartum stroke rates have not changed despite recommendations for closer follow up of postpartum patients. Hypertension remains a significant risk factor for postpartum stroke. The relatively stable rates over the study period may be due to unidentified barriers to effectively implementing guidelines and increasing traditional clinical stroke risk factors in the reproductive age population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)