(234) Increased rates of postpartum emergency department visits and inpatient readmissions in people with epilepsy

People with epilepsy face unique challenges during the postpartum period, and are more likely to be readmitted after delivery. However, little is known about their emergency department (ED) usage, which typically precedes readmission and may provide an opportunity for intervention. We compared ED encounters and readmission rates between people with and without epilepsy.

Study Design:

We performed a cohort study using linked birth certificate and hospital discharge record data to evaluate term, singleton livebirths in California from 2007-2018. The exposure was epilepsy, defined using diagnosis codes, and outcomes included ED visits and inpatient readmissions within 2 or 6 weeks post-discharge from birth hospitalization. Secondary outcomes included indications for ED visits. Multivariable logistic regression models were conducted (Table 1).

Results:

Out of 5,032,991 livebirths, 16,256 (0.3%) were to people with epilepsy. Of these, 1302 (8.0%) were generalized, 636 (3.9%) were focal, and 14,418 (88.2%) were less specified epilepsy subtypes. People with epilepsy had a higher rate of ED visits within 2 weeks (7.3% vs 3.1%, aOR 2.05, 95% CI [1.94-2.18]) and 6 weeks post-discharge (13.4% vs 5.3%, aOR 2.31, 95% CI [2.21-2.42]). Among those presenting to the ED within 2 weeks, the average time to ED visit in people with versus without epilepsy was similar (5.4 days [SD 3.7] vs 5.3 days [SD 3.6]). People with epilepsy also had a higher rate of inpatient readmission within 2 weeks (1.37% vs 0.65%, aOR 1.75, 95% CI [1.53-1.99] and within 6 weeks (2.38% vs 1.03%, aOR 1.97, 95% CI [1.78-2.22], Table 1). Among people with epilepsy, the three most common categories of conditions for ED visits were other, perinatal, and nervous system (Figure 1).

Conclusion:

Compared to people without epilepsy, people with epilepsy had higher rates of ED visits and hospital readmission at 2 and 6 weeks post-discharge. Given the significantly higher risk of re-presentation to the ED in the immediate postpartum period, closer outpatient follow up within 1-2 weeks from hospital discharge may alleviate this risk for people with epilepsy.