Mogos Mulubrhan F, Salemi Jason L, Ashley Mary, Whiteman Valerie E, Salihu Hamisu M
a Community and Health Systems, Indiana University , Indianapolis , IN , USA .
b Department of Family and Community Medicine , Baylor College of Medicine , Houston , TX , USA , and.
J Matern Fetal Neonatal Med. 2016;29(7):1077-82. doi: 10.3109/14767058.2015.1034103. Epub 2015 Apr 21.
To describe the prevalence, trends, adverse maternal-fetal morbidities and healthcare costs associated with placenta accreta (PA) in the United States (US) between 1998 and 2011.
A retrospective, cross-sectional analysis of inpatient hospital discharges was conducted using the National Inpatient Sample (NIS). We used International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes to identify both cases of PA and of selected comorbidities. Survey logistic regression was used to assess the association between PA and various maternal-fetal outcomes. Joinpoint regression modeling was used to estimate annual percent changes (APCs) in PA prevalence during the study period.
The prevalence of PA from 1998 to 2011 was 3.7 per 1000 delivery-related discharges. After adjusting for known or suspected confounders, PA conferred between a 20% to over a 19-fold increased odds of experiencing an adverse outcome. This resulted in a higher mean, per-hospitalization, cost of inpatient care after adjustment for inflation ($5561 versus $4989), translating into over $115 million dollars in additional inpatient expenditures relative to non-PA affected deliveries from 2001 to 2011.
This study updates recent trends in the prevalence of PA, which is valuable to clinicians and policymakers as they formulate targeted strategies to address factors related to PA.
描述1998年至2011年美国胎盘植入（PA）的患病率、趋势、母婴不良发病率及医疗费用。
使用全国住院患者样本（NIS）对住院患者出院情况进行回顾性横断面分析。我们使用国际疾病分类第九版临床修订本（ICD-9-CM）编码来识别PA病例和选定的合并症病例。采用调查逻辑回归评估PA与各种母婴结局之间的关联。使用Joinpoint回归模型估计研究期间PA患病率的年度百分比变化（APC）。
1998年至2011年，PA的患病率为每1000例与分娩相关的出院病例中有3.7例。在对已知或疑似混杂因素进行调整后，PA导致不良结局的几率增加了20%至19倍以上。这导致调整通货膨胀后每次住院的平均住院护理费用更高（5561美元对4989美元），相对于2001年至2011年未受PA影响的分娩，额外的住院支出超过1.15亿美元。
本研究更新了PA患病率的近期趋势，这对临床医生和政策制定者制定针对性策略以解决与PA相关的因素具有重要价值。
