Beyond Severe Maternal Morbidity: Exploring Reasons for ICU Transfer during Delivery Hospitalizations

Alana Davidson, BS, Rebecca S. Himmelwright, MD, Kait Brennan, DO, MPH, Matthew Fuller, MS, Ashraf S. Habib, MBBCh, MSc, MHSc, FRCA, Vijay Krishnamoorthy, MD, MPH, PhD, Jerome Federspiel, MD, PhD, Marie-Louise Meng, MD

Background

- ICU admission during delivery hospitalizations is rare but can be used as a marker of critical illness

- Most ICU admissions do not meet CDC criteria for SMM

Aims

1. Characterize the reasons for ICU admission in delivery hospitalizations not involving an SMM event

2. Evaluate the factors associated with non-SMM ICU admission

Hypothesis

ICU admissions without SMM are driven by patients with comorbid conditions and their need for monitoring

Study Design and Methods

• Retrospective cohort study using Premier database

• Descriptive analyses and multivariable logistic regression

Results

• 4.8 million deliveries analyzed

• ↑ ICU-level resource utilization in patients w/ SMM

• ↑ Non-SMM ICU admission associated with:

– Cardiomyopathy, pulmonary HTN, PEC

– Smaller hospitals (<400 beds)

Conclusions and Discussions

- ICU admission without SMM are not fully explained by expected ICU-level interventions

- ICU transfer may have unintended consequences

- More intentional ICU triage is needed