University of Miami Miller School of Medicine, Miami, FL, USA.
Kupot Holim Clalit, Jerusalem, Israel.
BJOG. 2021 Sep;128(10):1694-1702. doi: 10.1111/1471-0528.16693. Epub 2021 Apr 7.
To quantify the proportion of postpartum venous thromboembolism (VTE) readmissions, including those that occur at different hospitals from index admission, and describe risk factors for this outcome.
Retrospective observational study.
US hospitals included in the Nationwide Readmissions Database.
A total of 3 719 238 patients >14 years of age with a delivery-associated hospitalisation in 2014.
Univariate analysis was performed to identify patient and hospital factors associated with readmissions. Significant factors were included in multivariate logistic regression to identify independent risk factors. Results were weighted for national estimates.
Readmission with VTE to both index and different hospitals at 30, 60 and 90 days.
The VTE cumulative readmission rate was 0.053% (n = 1477), 0.063% (n = 1765) and 0.069% (n = 1938) at 30, 60 and 90 days, respectively. Patients were readmitted to different hospitals 31% of the time within 90 days. Risk factors for different hospital VTE readmission were unique and included younger age and initial admission to a small/medium-sized hospital. Initial admission to a for-profit hospital increased the likelihood of readmission to a different hospital.
Nearly one in three postpartum VTEs are missed by the current quality metrics, with significant implications for outcomes and quality. For-profit hospitals have a significant portion of their VTE readmissions hidden, falsely lowering their readmission rates relative to public hospitals.
US analysis shows 1 in 3 readmissions for postpartum venous thromboembolism currently missed.
量化产后静脉血栓栓塞症（VTE）再入院的比例，包括从索引入院到不同医院的再入院，并描述这一结果的危险因素。
回顾性观察性研究。
美国全国再入院数据库中包含的医院。
2014 年共有 3719238 名年龄>14 岁的与分娩相关的住院患者。
采用单因素分析确定与再入院相关的患者和医院因素。将有意义的因素纳入多变量逻辑回归模型，以确定独立的危险因素。结果进行了全国估计的加权处理。
30、60 和 90 天索引和不同医院的 VTE 再入院。
VTE 累积再入院率分别为 0.053%（n=1477）、0.063%（n=1765）和 0.069%（n=1938），30、60 和 90 天内分别为 31%的患者在 90 天内再入不同医院。不同医院 VTE 再入院的危险因素是独特的，包括年龄较小和初次入院到中小规模医院。初次入住营利性医院增加了再入住不同医院的可能性。
目前的质量指标错失了近三分之一的产后 VTE 再入院，这对结果和质量有重大影响。营利性医院有很大一部分 VTE 再入院被隐藏，使其再入院率相对于公立医院显著降低。
美国的分析显示，目前产后静脉血栓栓塞症的再入院中有 1/3被遗漏。
