Clapp M A, Robinson J N, Little S E
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
J Perinatol. 2017 Apr;37(4):355-359. doi: 10.1038/jp.2016.252. Epub 2017 Jan 12.
This study seeks to determine if the increasing rate of postpartum readmissions is related to the increasing rate of cesarean delivery.
Readmitted patients were identified in the State Inpatient Databases of California, Florida and New York from 2004 to 2011. Relevant maternal comorbidities, pregnancy complications and intrapartum events were collected using ICD-9 diagnosis and procedure codes. The effects of cesarean delivery were first examined via univariate logistic regression to calculate the odds of readmission by year for patients who had delivered via cesarean section. Then, we used multivariate logistic regression models to isolate the effect of mode of delivery on the odds of readmission by adjusting for the effects of patient demographics, hospital characteristics and maternal comorbidities.
Nearly one million deliveries were identified each year, and ~600 000 deliveries per year met inclusion criteria. During this time, the readmission rate increased from 1.72 to 2.16%, and the cesarean delivery rate increased from 30.4 to 33.9%. The odds of readmission for patients delivered via cesarean section decreased yearly, from 1.343 (95% CI: 1.295 to 1.392) in 2004 to 1.046 (95% CI: 1.012 to 1.108) in 2011. In a multivariate model, the odds based on year were 1.032 (95% CI: 1.030 to 1.035), demonstrating an increased odds of readmission over time. When cesarean delivery was added to the model, this odds estimate did not change (OR: 1.031, 95% CI: 1.028 to 1.035), suggesting it did not account for the increased odds of readmission over time, even though cesarean delivery rates increased. However, when maternal comorbidities were added to the model, the odds ratio for year became insignificant (OR: 1.001, 95% CI: 0.998 to 1.005), suggesting that they accounted for the increasing rate of readmissions.
The increasing cesarean delivery rate does not explain the increasing rate of postpartum readmissions. Rather, the increasing postpartum readmission rate appears to be related to maternal comorbidities.
本研究旨在确定产后再入院率的上升是否与剖宫产率的上升有关。
2004年至2011年期间，在加利福尼亚州、佛罗里达州和纽约州的住院患者数据库中识别再入院患者。使用ICD - 9诊断和程序代码收集相关的孕产妇合并症、妊娠并发症和分娩期事件。首先通过单因素逻辑回归分析剖宫产的影响，以计算剖宫产患者每年再入院的几率。然后，我们使用多因素逻辑回归模型，通过调整患者人口统计学、医院特征和孕产妇合并症的影响，来分离分娩方式对再入院几率的影响。
每年识别出近100万例分娩，每年约60万例分娩符合纳入标准。在此期间，再入院率从1.72%上升至2.16%，剖宫产率从30.4%上升至33.9%。剖宫产患者再入院的几率逐年下降，从2004年的1.343（95%可信区间：1.295至1.392）降至2011年的1.046（95%可信区间：1.012至1.108）。在多因素模型中，基于年份的几率为1.032（95%可信区间：1.030至1.035），表明随着时间推移再入院几率增加。当将剖宫产分娩纳入模型时，该几率估计值未改变（比值比：1.031，95%可信区间：1.028至1.035），这表明尽管剖宫产率上升，但它并不能解释随着时间推移再入院几率的增加。然而，当将孕产妇合并症纳入模型时，年份的比值比变得不显著（比值比：1.001，95%可信区间：0.998至1.005），这表明它们可以解释再入院率的上升。
剖宫产率上升并不能解释产后再入院率的上升。相反，产后再入院率上升似乎与孕产妇合并症有关。
