Effects of Delivery Volume and High-Risk Condition Volume on Maternal Morbidity Among High-Risk Obstetric Patients
Effects of Delivery Volume and High-Risk Condition Volume on Maternal Morbidity Among High-Risk Obstetric Patients
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DOI：
10.1097/aog.0000000000003080
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发表时间：
2019-02-01
影响因子：
7.2
通讯作者：
Srinivas, Sindhu
中科院分区：
文献类型：
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作者：
Bozzuto, Laura;Passarella, Molly;Srinivas, Sindhu
目的：为了评估产科分娩量，高风险的条件量，以及它们的综合效果对孕产妇outcome.METHODS：这项回顾性队列研究研究检查了10多万分娩在三个州从1995年至2009年使用链接的出生出院记录。手术高危患者患有产前可识别的三种疾病之一;高危医疗队列患有14种并发症诊断中的1种或多种。医院被分为产科总分娩量的四分位数和高危患者量的三分位数。主要结局是由国际疾病分类第9版临床修改编码确定的重度孕产妇发病率的复合结局。控制数据的非独立性使用聚类医院和结果进行了调整患者和医院水平的factors.Results：我们确定了142,194高风险的手术分娩和1,322,276高风险的医疗分娩进行评估。在外科高危患者中，较高的医院产科总分娩量与孕产妇发病风险降低22%相关（第四个四分位数调整的比值比[AOR] 0.78; 95% CI 0.64-0.94）;同样，对于医学高风险患者，更高的总输注量与28%的风险降低相关（第四个四分位数AOR 0.72; 95% CI 0.59-0.86）。相反，随着医院医疗高风险患者数量的增加，重度发病率的AOR增加（AOR=1.27，95% CI 1.10-1.48）。对于外科（似然比[LR] chi（2）=18.2，P= 0.006）和内科高危患者（LR chi（2）=99.4，P
OBJECTIVE: To evaluate the effect of obstetric delivery volume, high-risk condition volume, and their combined effect on maternal outcomes.METHODS: This retrospective cohort study examined more than 10 million deliveries in three states from 1995 to 2009 using linked birth-hospital discharge records. Surgical high-risk patients had one of three prenatally identifiable conditions; the high-risk medical cohort had 1 or more of 14 complicating diagnoses. Hospitals were divided into quartiles of total obstetric delivery volume and tertiles of high-risk patient volume. The primary outcome was a composite outcome of severe maternal morbidity identified by International Classification of Diseases, 9th Revision, Clinical Modification, codes. Data were controlled for nonindependence using clustering by hospital and results were adjusted for patient and hospital level factors.RESULTS: We identified 142,194 high-risk surgical deliveries and 1,322,276 high-risk medical deliveries for evaluation. Among surgical high-risk patients, higher hospital total obstetric delivery volume was associated with 22% decreased risk for maternal morbidity (4th quartile adjusted odds ratio [AOR] 0.78; 95% CI 0.64-0.94); likewise for medical high-risk patients, higher total delivery volume was associated with a 28% decreased risk (4th quartile AOR 0.72; 95% CI 0.59-0.86). Conversely, as the volume of medical high-risk patients at hospitals increased, the AOR for severe morbidity increased (AOR=1.27, 95% CI 1.10-1.48). There was a significant interaction effect of both types of volume on maternal complications for both surgical (likelihood ratio [LR] chi(2)=18.2, P=.006) and medical high-risk patients (LR chi(2)=99.4, P