忙碌日效应对分娩期间产科干预措施和硬膜外镇痛使用的影响：一项针对 601247 例分娩的横断面登记研究。
Busy day effect on the use of obstetrical interventions and epidural analgesia during labour: a cross-sectional register study of 601 247 deliveries.
机构信息
Faculty of Medicine, Doctoral Programme in Clinical Research, University of Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland.
Tampere University of Applied Sciences, Kuntokatu 3, 33520, Tampere, Finland.
出版信息
BMC Pregnancy Childbirth. 2022 Jun 13;22(1):481. doi: 10.1186/s12884-022-04798-6.
BACKGROUND
Daily delivery volume might affect the quality of obstetric care. We explored the busy day effect on selected obstetrical interventions and epidural analgesia performed during labour in different sized delivery hospitals and on the Finnish obstetric ecosystem.
METHODS
We conducted a cross-sectional study on Finnish Medical Birth Register data of singleton pregnancies (N = 601,247) from 26 delivery hospitals from 2006 to 2016. Delivery hospitals were stratified by annual delivery volume: C (category) 1: < 1000, C2: 1000-1999, C3: 2000-2999, C4: ≥3000, and C5: university hospitals. The exposure variables were defined as quiet, optimal, and busy days determined based on daily delivery volume distribution in each hospital category. Quiet and busy days included approximately 10% of the lowest and highest delivery volume days, while the rest were defined as optimal. Outcome measures were unplanned caesarean section (CS), instrumental delivery, induction of labour, and epidural analgesia. We compared the incidence of outcomes in quiet vs. optimal, busy vs. optimal, and busy vs. quiet days using logistic regression. The statistical significance level was set at 99% to reduce the likelihood of significant spurious findings.
RESULTS
In the total population, the incidence of instrumental delivery was 8% (99% CI 2-15%) lower on quiet than on optimal days. In smaller hospitals (C1 and C2), unplanned caesarean sections were performed up to one-third less frequently on busy than optimal and quiet days. More (27%, 99% CI 12-44%) instrumental deliveries were performed in higher delivery volume hospitals (C4) on busy than quiet days. In C1-C3, deliveries were induced (12-35%) less often and in C5 (37%, 99% CI 28-45%) more often on busy than optimal delivery days. More (59-61%) epidural analgesia was performed on busy than optimal and quiet days in C4 and 8% less in C2 hospitals.
CONCLUSIONS
Pooled analysis showed that busyness had no effect on outcomes at the obstetric ecosystem level, but 10% fewer instrumental deliveries were performed in quiet than on busy days overall. Furthermore, dissecting the data shows that small hospitals perform less, and large non-tertiary hospitals perform more interventions during busy days.
背景
每日分娩量可能会影响产科护理质量。我们探讨了繁忙日效应对不同规模分娩医院和芬兰产科生态系统中分娩时选择的产科干预措施和硬膜外镇痛的影响。
方法
我们对芬兰医疗出生登记数据进行了一项横断面研究，该数据包括 2006 年至 2016 年间 26 家分娩医院的 601247 例单胎妊娠。根据每家医院的年度分娩量，将分娩医院分为以下几类：C（类别）1：<1000、C2：1000-1999、C3：2000-2999、C4：≥3000 和 C5：大学医院。暴露变量定义为根据每家医院类别中每日分娩量分布确定的安静、最佳和繁忙日。安静和繁忙日包括最低和最高分娩量日的约 10%，其余的则定义为最佳日。结局指标为计划性剖宫产术（CS）、器械分娩、引产和硬膜外镇痛。我们使用逻辑回归比较了安静日与最佳日、繁忙日与最佳日以及繁忙日与安静日之间结局的发生率。统计学显著性水平设为 99%，以降低显著虚假发现的可能性。
结果
在总人群中，安静日器械分娩的发生率比最佳日低 8%（99%CI 2-15%）。在较小的医院（C1 和 C2），与最佳日和安静日相比，繁忙日的计划性剖宫产术的发生率降低了三分之一。在分娩量较高的医院（C4），繁忙日的器械分娩率比安静日高 27%（99%CI 12-44%）。在 C1-C3，诱导分娩的发生率（12-35%）较低，而在 C5（37%，99%CI 28-45%），繁忙日的诱导分娩率较高。与最佳日和安静日相比，C4 医院的硬膜外镇痛使用率增加 59-61%，C2 医院的硬膜外镇痛使用率减少 8%。
结论
汇总分析表明，忙碌日对产科生态系统层面的结局没有影响，但总体而言，安静日的器械分娩量比忙碌日减少 10%。此外，对数据进行细分表明，小医院在忙碌日进行的干预措施较少，而大型非三级医院在忙碌日进行的干预措施较多。
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