Department of Obstetrics and Gynecology and the Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; the Pharmacy Department, Rotunda Hospital, and the Division of Population Health Sciences, Royal College of Surgeons, Dublin, Ireland; and the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California.
Obstet Gynecol. 2022 Feb 1;139(2):223-234. doi: 10.1097/AOG.0000000000004648.
To characterize trends in and risk factors for venous thromboembolism (VTE) during delivery hospitalizations in the United States.
The 2000-2018 National Inpatient Sample was used for this repeated cross-sectional analysis. Venous thromboembolism (including deep vein thrombosis [DVT] and pulmonary embolism) during delivery hospitalizations for women aged 15 to 54 years was determined by year. Temporal trends in VTE were characterized using joinpoint regression with estimates presented as the average annual percent change. Temporal trends in common VTE risk factors were also analyzed. The proportion of vaginal and cesarean deliveries by year that had VTE risk factors was determined, and average annual percent changes with 95% CIs were calculated. The relationship between risk factors and the likelihood of VTE events was determined with adjusted and unadjusted logistic regression models.
Of 73,109,789 delivery hospitalizations, 48,546 VTE events occurred (6.6/10,000 deliveries), including 37,312 DVT diagnoses and 12,487 pulmonary embolism diagnoses. Rates increased significantly for vaginal (average annual percent change 2.5%, 95% CI 1.5-3.5%) but not for cesarean delivery hospitalizations (average annual percent change 0.3%, 95% CI -1.0 to 1.6%) over the study period. Pulmonary embolism increased for both vaginal delivery (average annual percent change 8.7%, 95% CI 6.0-11.5%) and cesarean delivery (average annual percent change 4.9%, 95% CI 3.6-6.2%). The proportion of cesarean deliveries with at least one VTE risk factor increased from 27.2% in 2000 to 43.6% in 2018 (average annual percent change 2.6%, 95% CI 2.2-3.1%) and for vaginal deliveries, from 17.7% to 31.4% (average annual percent change 3.4%, 95% CI 2.3-4.4%). The 5.9% of deliveries with at least two VTE risk factor diagnoses accounted for 25.4% of VTE diagnoses. Factors with the highest VTE risk included transfusion (adjusted odds ratio [aOR] 4.1, 95% CI 3.7-4.5), infection (aOR 5.8, 95% CI 5.3-6.3), history of VTE (aOR 7.2, 95% CI 6.2-8.4), and thrombophilias (aOR 9.6, 95% CI 8.5-11.0).
Both risk factors for VTE and rate of pulmonary embolism increased over the study period. Deep vein thrombosis increased during vaginal delivery hospitalizations but not during cesarean delivery hospitalizations.
描述美国分娩住院期间静脉血栓栓塞症（VTE）的趋势和危险因素。
本重复横断面分析使用了 2000 年至 2018 年的国家住院患者样本。通过年份确定了 15 至 54 岁女性分娩住院期间的静脉血栓栓塞症（包括深静脉血栓形成[DVT]和肺栓塞）。使用 Joinpoint 回归描述 VTE 的时间趋势，并以平均年百分比变化表示估计值。还分析了常见 VTE 危险因素的时间趋势。确定了每年具有 VTE 危险因素的阴道分娩和剖宫产分娩的比例，并计算了平均年百分比变化和 95%CI。使用调整和未调整的逻辑回归模型确定了危险因素与 VTE 事件发生的可能性之间的关系。
在 73109789 例分娩住院中，有 48546 例发生了 VTE 事件（每 10000 例分娩中有 6.6 例），包括 37312 例 DVT 诊断和 12487 例肺栓塞诊断。在研究期间，阴道分娩的发生率显著增加（平均年百分比变化 2.5%，95%CI 1.5-3.5%），但剖宫产分娩的发生率没有显著增加（平均年百分比变化 0.3%，95%CI -1.0 至 1.6%）。阴道分娩和剖宫产分娩的肺栓塞发生率均有所增加（阴道分娩的平均年百分比变化为 8.7%，95%CI 6.0-11.5%；剖宫产的平均年百分比变化为 4.9%，95%CI 3.6-6.2%）。至少有一种 VTE 危险因素的剖宫产分娩比例从 2000 年的 27.2%增加到 2018 年的 43.6%（平均年百分比变化为 2.6%，95%CI 2.2-3.1%），阴道分娩的比例从 17.7%增加到 31.4%（平均年百分比变化为 3.4%，95%CI 2.3-4.4%）。至少有两种 VTE 危险因素诊断的分娩占 VTE 诊断的 5.9%。具有最高 VTE 风险的因素包括输血（调整后的优势比[aOR]4.1，95%CI 3.7-4.5）、感染（aOR 5.8，95%CI 5.3-6.3）、VTE 病史（aOR 7.2，95%CI 6.2-8.4）和血栓形成倾向（aOR 9.6，95%CI 8.5-11.0）。
在研究期间，VTE 的危险因素和肺栓塞发生率均有所增加。阴道分娩期间 DVT 增加，但剖宫产分娩期间没有增加。
