A 'busy day' effect on perinatal complications of delivery on weekends: a retrospective cohort study.
A 'busy day' effect on perinatal complications of delivery on weekends: a retrospective cohort study.
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“忙碌的一天”对周末分娩围产期并发症的影响：一项回顾性队列研究。
DOI：
10.1136/bmjqs-2016-005257
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发表时间：
2017-01
影响因子：
5.4
通讯作者：
McConnell KJ
中科院分区：
文献类型：
--
作者：
Snowden JM;Kozhimannil KB;Muoto I;Caughey AB;McConnell KJ
评估在加州医院分娩的产妇和新生儿并发症是否与分娩和分娩单位的忙碌日相关，考虑工作日/周末分娩。这是一项基于人群的回顾性队列研究。链接的生命统计/病人出院数据加州出生在2009年和2010年之间从全州卫生规划和发展办公室。2009年至2010年期间所有单胎、头位、非异常加州出生（N=724 967）。 主要暴露是高日产科量，定义为在分娩数量超过医院特定日分娩量第75百分位数的当天分娩。结果是一系列的产妇和新生儿并发症。在调整产妇人口统计学、每年医院出生量和教学医院状况后，在高流量日和周末，几种产妇和新生儿并发症增加。例如，与低流量工作日相比，低流量周末和高流量周末Apgar <7的几率分别为11%（调整后OR（aOR）1.11，CI 1.03至1.21）和29%（aOR 1.29，CI 1.10至1.52）。高容量与工作日新生儿癫痫发作（aOR 1.33，CI 1.01至1.71）和周末出血（aOR 1.11，CI 1.01至1.22）的几率增加相关。在考虑了医院间差异后，周末分娩与Apgar评分<7的几率增加、新生儿入住重症监护室、母亲住院时间延长以及新生儿癫痫发作的几率在高容量工作日仍然增加显著相关。我们的研究结果表明，周末分娩是一系列围产期并发症的一个一致的风险因素，医院处理激增的数量可能存在差异。
To evaluate whether busy days on a labour and delivery unit are associated with maternal and neonatal complications of childbirth in California hospitals, accounting for weekday/weekend births. This is a population-based retrospective cohort study. Linked vital statistics/patient discharge data for California births between 2009 and 2010 from the Office of Statewide Health Planning and Development. All singleton, cephalic, non-anomalous California births between 2009 and 2010 (N=724 967). The key exposure was high daily obstetric volume, defined as giving birth on a day when the number of births exceeded the hospital-specific 75th percentile of daily delivery volume. Outcomes were a range of maternal and neonatal complications. Several maternal and neonatal complications were increased on high-volume days and weekends following adjustment for maternal demographics, annual hospital birth volume and teaching hospital status. For example, compared with low-volume weekdays, the odds of Apgar <7 on low-volume weekend days and high-volume weekend days were 11% (adjusted OR (aOR) 1.11, CI 1.03 to 1.21) and 29% higher (aOR 1.29, CI 1.10 to 1.52), respectively. High volume was associated with increased odds of neonatal seizures on weekdays (aOR 1.33, CI 1.01 to 1.71) and haemorrhage on weekends (aOR 1.11, CI 1.01 to 1.22). After accounting for between-hospital variation, weekend delivery remained significantly associated with increased odds of Apgar score <7, neonatal intensive care unit admission, prolonged maternal length of stay and the odds of neonatal seizures remained increased on high-volume weekdays. Our findings suggest that weekend delivery is a consistent risk factor for a range of perinatal complications and there may be variability in how well hospitals handle surges in volume.