Mothers at Risk Factors Affecting Maternal Postpartum Length of Stay
Mothers at Risk Factors Affecting Maternal Postpartum Length of Stay
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DOI：
10.1097/jpn.0000000000000342
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发表时间：
2018-10-01
影响因子：
1.3
通讯作者：
Main, Elliott
中科院分区：
文献类型：
--
作者：
Van Otterloo, Lucy;Connelly, Cynthia;Main, Elliott
与产妇合并症相关的围产期并发症通过延长产后住院时间（LOS）增加了医疗保健利用率。了解影响产后LOS的因素可以最大限度地减少与合并症和并发症相关的不良反应。本研究的目的是确定增加产后LOS几率最大的危险因素。使用2008-2009年出院和出生证明数据，检查1015424例出生的合并症和并发症代码。延长LOS（阴道：>5天/剖腹产：>6天）的总体发生率为每1000例活产3.63例。17%的妊娠出现并发症; 1%出现多种并发症。慢性高血压与阴道分娩和剖宫产的住院时间延长相关（比值比[OR] = 5.89 [95%CI，4.39-7.88]; OR = 3.57 [95%CI，3.05-4.17]）。产褥感染（OR = 6.86 [95%CI，5.73-8.21]）、子痫（OR = 17.07 [95%CI，13.76-21.17]）和输血（OR = 11.66 [95%CI，9.20-14.75]）发生率最高，并使阴道分娩的住院时间延长的几率最高。脑血管疾病（OR = 15.32 [95%CI，11.90-19.60]）和感染（OR = 15.35 [95%CI，10.11-23.32]）导致剖宫产延长LOS的几率最高。越早认识到风险因素，就能越早启动优化组织准备的进程，从而减少不良孕产妇结局和延长住院时间。
Perinatal complications linked to maternal comorbidities contribute to increased healthcare utilization through an extended postpartum length of stay (LOS). Understanding factors influencing postpartum LOS may minimize the adverse effects associated with comorbidities and complications. The purpose of this study was to identify risk factors with the greatest odds of increasing postpartum LOS. Linked 2008-2009 hospital discharge and birth certificate data were used to examine comorbidities and complication codes in 1 015 424 births. The overall rate for an extended LOS (vaginal: >5 days/cesarean: >6 days) was 3.63 per 1000 live births. Complications were present in 17% of pregnancies; multiple complications were seen in 1%. Chronic hypertension was associated with an extended stay for both vaginal and cesarean births (odds ratio [OR] = 5.89 [95% CI, 4.39-7.88]; OR = 3.57 [95% CI, 3.05-4.17], respectively). Puerperal infections (OR = 6.86 [95% CI, 5.73-8.21]), eclampsia (OR = 17.07 [95% CI, 13.76-21.17]), and transfusions (OR = 11.66 [95% CI, 9.20-14.75]) occurred most frequently and conferred the highest odds of an extended stay for vaginal births. Cerebrovascular conditions (OR = 15.32 [95% CI, 11.90-19.60]) and infection (OR = 15.35 [95% CI, 10.11-23.32]) conferred the highest odds of an extended LOS for cesarean births. The earlier risk factors are recognized, the sooner processes can be initiated to optimize organizational preparation, thus decreasing adverse maternal outcomes and extended hospital stays.