Phibbs Ciaran S, Passarella Molly, Schmitt Susan K, Martin Ashley, Lorch Scott A
Health Economics Resource Center and Center for Implementation to Innovation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Department of Health Policy, Stanford University School of Medicine, Stanford, CA.
Department of Pediatrics, University of Pennsylvania, Philadelphia, PA; Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr. 2025 Jan;276:114323. doi: 10.1016/j.jpeds.2024.114323. Epub 2024 Sep 18.
To examine if the annual patient volume of infants born very preterm (VPT, gestational age <32 weeks) at a hospital is associated with neonatal mortality and morbidity.
We performed an observational, secondary data analysis using a 20-year panel of birth certificates linked to hospital discharge abstracts, including transfers in California, Michigan, Missouri, Oregon, Pennsylvania, and South Carolina from 1996 through 2015. The study included all in-hospital VPT deliveries (n = 208 261). Study outcomes were in-hospital mortality or serious morbidity (intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, or bronchopulmonary dysplasia), attributed to the hospital of birth. Poisson regression models estimated the risk-adjusted relative risk (RR) for mortality and serious morbidity across different patient volume categories within a given hospital using hospital fixed effects.
The risk of mortality and serious morbidity for VPT infants increased as the number of infants born VPT at a hospital decreased. Compared with VPT delivery volumes >100 infants per year, the risk of mortality increased when a given hospital had VPT delivery volumes < 60 per year, ranging from a RR of 1.13 (95% C.I. 1.02-1.25) for volumes between 50 to 59 and 1.39 (1.19-1.62) for VPT volumes <10, and the risk of mortality or serious morbidity increased when a given hospital had VPT volumes <100, ranging from a RR of 1.05 (1.02-1.08) for volumes between 90 to 99 and 1.27 (1.19-1.36) for VPT volumes <10.
These results suggest that, for VPT infants, the risk of both mortality and mortality or serious morbidity is increased as the VPT volume within a given hospital declines.
研究医院每年极早产儿（VPT，胎龄<32周）的出生量是否与新生儿死亡率及发病率相关。
我们进行了一项观察性二次数据分析，使用了一个为期20年的出生证明面板，该面板与医院出院摘要相关联，包括1996年至2015年加利福尼亚州、密歇根州、密苏里州、俄勒冈州、宾夕法尼亚州和南卡罗来纳州的转诊情况。该研究纳入了所有在医院分娩的极早产儿（n = 208261）。研究结局为住院死亡率或严重发病率（脑室内出血、坏死性小肠结肠炎、早产儿视网膜病变或支气管肺发育不良），归因于出生医院。泊松回归模型使用医院固定效应估计了给定医院内不同患者数量类别中死亡率和严重发病率的风险调整相对风险（RR）。
随着医院极早产儿出生数量的减少，极早产儿的死亡率和严重发病率风险增加。与每年极早产儿出生量>100例相比，当给定医院每年极早产儿出生量<60例时，死亡率风险增加，出生量在50至59例之间时RR为1.13（95%置信区间1.02 - 1.25），出生量<10例时为1.39（1.19 - 1.62）；当给定医院极早产儿出生量<100例时，死亡率或严重发病率风险增加，出生量在90至99例之间时RR为1.05（1.02 - 1.08），出生量<10例时为1.27（1.19 - 1.36）。
这些结果表明，对于极早产儿，随着给定医院内极早产儿出生量的下降，死亡率以及死亡率或严重发病率的风险均会增加。
