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2012-2017 年俄勒冈州产后 1 年内有无严重产妇病状的住院再入院情况。

Postpartum Hospital Readmissions With and Without Severe Maternal Morbidity Within 1 Year of Birth, Oregon, 2012-2017.

出版信息

Am J Epidemiol. 2023 Feb 1;192(2):158-170. doi: 10.1093/aje/kwac183.

Abstract

Postpartum readmissions (PPRs) represent a critical marker of maternal morbidity after hospital childbirth. Most severe maternal morbidity (SMM) events result in a hospital admission, but most PPRs do not have evidence of SMM. Little is known about PPR and SMM beyond the first 6 weeks postpartum. We examined the associations of maternal demographic and clinical factors with PPR within 12 months postpartum. We categorized PPR as being with or without evidence of SMM to assess whether risk factors and timing differed. Using the Oregon All Payer All Claims database, we analyzed hospital births from 2012-2017. We used log-binomial regression to estimate associations between maternal factors and PPR. Our final analytical sample included 158,653 births. Overall, 2.6% (n = 4,141) of births involved at least 1 readmission within 12 months postpartum (808 (19.5% of PPRs) with SMM). SMM at delivery was the strongest risk factor for PPR with SMM (risk ratio (RR) = 5.55, 95% confidence interval (CI): 4.14, 7.44). PPR without SMM had numerous risk factors, including any mental health diagnosis (RR = 2.10, 95% CI: 1.91, 2.30), chronic hypertension (RR = 2.17, 95% CI: 1.85, 2.55), and prepregnancy diabetes (RR = 2.85, 95% CI: 2.47, 3.30), all which were on par with SMM at delivery (RR = 1.89, 95% CI: 1.49, 2.40).

摘要

产后再入院(PPR)是产后产妇发病率的一个重要标志。大多数严重产妇发病率(SMM)事件导致住院,但大多数 PPR 没有 SMM 的证据。产后 6 周后,人们对 PPR 和 SMM 知之甚少。我们研究了产妇人口统计学和临床因素与产后 12 个月内 PPR 的关系。我们将 PPR 分为有或没有 SMM 证据,以评估风险因素和时间是否存在差异。我们使用俄勒冈州全支付者全索赔数据库,分析了 2012-2017 年的医院分娩。我们使用对数二项式回归来估计产妇因素与 PPR 之间的关联。我们的最终分析样本包括 158653 例分娩。总体而言,有 2.6%(n=4141)的分娩在产后 12 个月内至少有一次再入院(808 例(PPR 的 19.5%)有 SMM)。分娩时的 SMM 是 PPR 伴 SMM 的最强危险因素(风险比(RR)=5.55,95%置信区间(CI):4.14,7.44)。无 SMM 的 PPR 有许多危险因素,包括任何心理健康诊断(RR=2.10,95%CI:1.91,2.30)、慢性高血压(RR=2.17,95%CI:1.85,2.55)和孕前糖尿病(RR=2.85,95%CI:2.47,3.30),所有这些与分娩时的 SMM 相当(RR=1.89,95%CI:1.49,2.40)。

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