Hospital delivery volume, severe obstetrical morbidity, and failure to rescue.
Hospital delivery volume, severe obstetrical morbidity, and failure to rescue.
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DOI：
10.1016/j.ajog.2016.07.039
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发表时间：
2016-12
影响因子：
9.8
通讯作者：
Wright, Jason D.
中科院分区：
文献类型：
--
作者：
Friedman, Alexander M.;Ananth, Cande V.;Huang, Yongmei;D'Alton, Mary E.;Wright, Jason D.
在孕产妇死亡率和严重产科发病率持续高风险的背景下，人们对医院分娩量与孕产妇结局之间的关系知之甚少。本分析的目的是（i）确定在美国按医院分娩量划分的分娩住院期间产妇发生严重发病的风险;（ii）按医院分娩量划分的严重产科发病情况下的死亡风险特征--这一概念被称为抢救失败。这项队列研究评估了1998年至2010年美国50，433，539例分娩住院。主要结局指标为（i）严重发病率，定义为代表急性器官损伤和危重病的15种诊断中的任何一种的复合，以及（ii）抢救失败，定义为在严重发病率情况下死亡。从1998年到2010年，严重发病率从每10万例分娩471.2例增加到751.5例，增加了59.5%。1998年，救援失败率最高（1.5%），2007年下降到0.6%，2010年上升到0.9%。在校正合并症风险和医院因素的模型中，低和高的年分娩量均与抢救失败和严重发病率的风险增加相关。然而，与其他因素相比，医院容量对两种结局的相对重要性相对较小。虽然低和高分娩量与抢救失败和严重孕产妇发病率的风险增加有关，但其他因素，特别是各个中心的特征，在确定结局时可能更重要。
In the setting of persistently high risk for maternal mortality and severe obstetric morbidity, little is known about the relationship between hospital delivery volume and maternal outcomes. The objectives of this analysis were (i) to determine maternal risk for severe morbidity during delivery hospitalizations by hospital delivery volume in the United States; and (ii) to characterize, by hospital volume, the risk for mortality in the setting of severe obstetrical morbidity – a concept known as failure to rescue. This cohort study evaluated 50,433,539 delivery hospitalizations across the United States from 1998 to 2010. The main outcome measures were (i) severe morbidity defined as a composite of any one of fifteen diagnoses representative of acute organ injury and critical illness, and (ii) failure to rescue, defined as death in the setting of severe morbidity. The prevalence of severe morbidity rose from 471.2 to 751.5 cases per 100,000 deliveries from 1998 to 2010, an increase of 59.5%. Failure to rescue was highest in 1998 (1.5%), decreased to 0.6% in 2007, and rose to 0.9% in 2010. In models adjusted for comorbid risk and hospital factors, both low and high annualized delivery volume were associated with increased risk for failure to rescue and severe morbidity. However, the relative importance of hospital volume for both outcomes compared to other factors was relatively small. While low and high delivery volume are associated with increased risk for both failure to rescue and severe maternal morbidity, other factors, in particular characteristics of individual centers, may be more important in determining outcomes.
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影响因子：
2
作者：
DURRLEMAN, S;SIMON, R
通讯作者：
SIMON, R
影响因子：
9.8
作者：
Creanga, Andreea A.;Bateman, Brian T.;Callaghan, William M.
通讯作者：
Callaghan, William M.
影响因子：
9
作者：
Ghaferi, Amir A.;Birkmeyer, John D.;Dimick, Justin B.
通讯作者：
Dimick, Justin B.
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
DOI：
10.1111/1471-0528.13254
发表时间：
2015-12-01
影响因子：
5.8
作者：
Metcalfe, A.;Lix, L. M.;Tough, S. C.
通讯作者：
Tough, S. C.