Siochi Christian, Segura Torres Danny, Cervantes Wilmer, Rabadi Marie, Machado Carvalhais Ricardo, Sobieraj Peter, Jesmajian Stephen
Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA.
Cureus. 2024 Nov 19;16(11):e74039. doi: 10.7759/cureus.74039. eCollection 2024 Nov.
Atrial fibrillation (AF) is rare during pregnancy and current data on the impact of AF during delivery is scarce. In this study, we aim to analyze the impact of AF in patients who underwent delivery via cesarean section (CS), natural spontaneous delivery (NSD), or instrumental delivery (ID).
This study analyzed discharge data from the National Inpatient Sample (NIS) from 2016 to 2020. Using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and Procedure Coding System (ICD-10-PCS) codes, this study identified patients who underwent CS, NSD, or ID with a secondary diagnosis of AF. The study then compared these patients with patients who underwent CS, NSD, or ID without a secondary diagnosis of AF to analyze various outcomes. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included length of stay, total hospital charges, blood transfusions, and respiratory failure requiring endotracheal intubation. STATA v.13 (StataCorp LLC, College Station, TX) was used for univariate and multivariate analysis.
A total of 17,785,980 patients underwent CS, NSD, or ID. Of these deliveries, 6,000 patients had a secondary diagnosis of AF. Patients with AF had almost 20 times more of a chance of dying while admitted compared to those without AF (OR: 19.12; 95% CI: 4.33-84.45; p < 0.001). Furthermore, the AF cohort stayed for one and a half days longer in the hospital (regression coefficient: 1.55; 95% CI: 1.16-1.94; p < 0.001), spent 19,294.05 more dollars (regression coefficient: 19294.05; 95% CI: 14658.17-23929.93; p < 0.001), were subjected 2.68 times more to blood transfusions (OR: 2.68; 95% CI: 1.89-3.8; p < 0.001), and had a higher rate of respiratory complications requiring endotracheal intubation (OR: 15.86; 95% CI: 7.83-32.15; p < 0.001).
AF has a substantial negative impact on inpatient outcomes for pregnant patients during delivery. Further research is needed to explore these negative impacts to improve maternal care.
心房颤动（AF）在孕期较为罕见，目前关于分娩期间AF影响的数据稀缺。在本研究中，我们旨在分析AF对接受剖宫产（CS）、自然顺产（NSD）或器械助产（ID）的患者的影响。
本研究分析了2016年至2020年国家住院患者样本（NIS）的出院数据。使用国际疾病分类第十版临床修订本（ICD-10-CM）和手术编码系统（ICD-10-PCS）编码，本研究确定了接受CS、NSD或ID且二级诊断为AF的患者。然后将这些患者与接受CS、NSD或ID但二级诊断无AF的患者进行比较，以分析各种结局。主要结局是全因住院死亡率。次要结局包括住院时间、总住院费用、输血以及需要气管插管的呼吸衰竭。使用STATA v.13（StataCorp有限责任公司，德克萨斯州大学城）进行单变量和多变量分析。
共有17,785,980名患者接受了CS、NSD或ID。在这些分娩中，6000名患者有AF的二级诊断。与无AF的患者相比，AF患者住院期间死亡几率几乎高20倍（比值比：19.12；95%置信区间：4.33 - 84.45；p < 0.001）。此外，AF队列在医院停留时间长1.5天（回归系数：1.55；95%置信区间：1.16 - 1.94；p < 0.001），多花费19,294.05美元（回归系数：19294.05；95%置信区间：14658.17 - 23929.93；p < 0.001），输血次数多2.68倍（比值比：2.68；95%置信区间：1.89 - 3.8；p < 0.001），且需要气管插管的呼吸并发症发生率更高（比值比：15.86；95%置信区间：7.83 - 32.15；p < 0.001）。
AF对分娩期间妊娠患者的住院结局有重大负面影响。需要进一步研究以探索这些负面影响，从而改善孕产妇护理。
