| Literature DB >> 30840695 |
Luca Cegolon, Oona Campbell, Salvatore Alberico, Marcella Montico, Giuseppe Mastrangelo, Lorenzo Monasta, Luca Ronfani, Fabio Barbone.
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0204919.].Entities:
Year: 2019 PMID: 30840695 PMCID: PMC6402662 DOI: 10.1371/journal.pone.0213664
Source DB: PubMed Journal: PLoS One ISSN: 1932-6203 Impact factor: 3.240
Fig 1Flowchart displaying the various criteria applied to the initial database to obtain the final number of hospital records available for the analysis.
SVD = spontaneous vaginal deliveries; IVD = instrumental vaginal deliveries; CS = cesarean sections.
Fig 2Conceptual framework explaining the relationship between various determinants and length of hospital stay after childbirth (LoS).
Distribution of length of stay (LoS) after childbirth by maternal health factors.
Number; mean LoS (M) ± standard deviation (SD); row percentage (row %). NA = Not applicable.
| FACTORS | STRATA | ALL BIRTHS | VAGINAL DELIVERY MODE | |||
|---|---|---|---|---|---|---|
| Number | M ± SD | SPONTANEOUS | INSTRUMENTAL | |||
| LoS >2 days | LoS > 3 days | |||||
| Spontaneous | 75,497 | 2.9 ± 1.1 | 64.4 | |||
| Instrumental | 7,281 | 3.3 ± 1.3 | 32.0 | |||
| Caesarean | 26,467 | 4.7 ± 1.7 | ||||
| 15–19 | 1,254 | 3.4 ± 1.5 | 72.0 | 31.5 | ||
| 20–24 | 9,485 | 3.3 ± 1.5 | 68.7 | 34.7 | ||
| 25–29 | 23,675 | 3.3 ± 1.4 | 65.6 | 27.8 | ||
| 30–34 | 38,381 | 3.3 ± 1.4 | 63.5 | 32.5 | ||
| 35–39 | 28,860 | 3.4 ± 1.5 | 62.8 | 32.6 | ||
| 40–44 | 7,214 | 3.6 ± 1.6 | 62.8 | 37.9 | ||
| 45+ | 345 | 4.3 ± 2.3 | 74.8 | 40.0 | ||
| No | 106,690 | 3.3 ± 1.4 | 64.2 | 31.8 | ||
| Yes | 2,493 | 4.5 ± 2.4 | 74.6 | 41.8 | ||
| No | 105,993 | 3.3 ± 1.5 | 64.3 | 32.0 | ||
| Yes | 4,247 | 3.5 ± 1.5 | 67.5 | 32.0 | ||
| No | 91,986 | 3.3 ± 1.5 | 64.2 | 31.2 | ||
| Yes | 17,254 | 3.5 ±1.5 | 65.5 | 36.6 | ||
| No | 108,892 | 3.3 ± 1.5 | 64.4 | 32.0 | ||
| Yes | 348 | 3.4 ±1.5 | 66.8 | 37.9 | ||
| <4 | 20,856 | 3.5 ± 1.6 | 65.4 | 35.3 | ||
| 4–7 | 65,800 | 3.3 ± 1.4 | 66.6 | 32.3 | ||
| 8+ | 22,589 | 3.3 ± 1.5 | 56.7 | 28.8 | ||
| <4 | 19,003 | 3.1 ± 1.4 | 56.5 | 25.7 | ||
| 4–5 | 52,873 | 3.3 ± 1.4 | 62.6 | 28.6 | ||
| 6+ | 37,363 | 3.6 ± 1.6 | 72.1 | 36.9 | ||
| No | 89,536 | 3.3 ± 1.5 | 63.6 | 28.5 | ||
| Yes | 19,526 | 3.3 ± 1.4 | 67.7 | 38.1 | ||
| No | 81,859 | 2.9 ± 1.1 | 64.1 | 31.0 | ||
| Yes | 27,319 | 4.6 ± 1.7 | 82.6 | 51.5 | ||
| Liveborn | 108,944 | 3.4 ± 1.5 | 64.5 | 32.1 | ||
| Stillborn | 302 | 2.8 ± 2.8 | 12.3 | 6.7 | ||
| <3 | 103,769 | 3.3 ± 1.4 | 64.3 | 31.8 | ||
| 3–5 | 3,142 | 4.1 ± 2.0 | 68.8 | 35.6 | ||
| 6+ | 1,741 | 5.0 ± 2.9 | 69.3 | 45.8 | ||
| Spontaneous | 75,118 | 2.9 ± 1.0 | 64.4 | |||
| Instrumental | 7,248 | 3.3 ± 1.3 | 32.0 | |||
| Spontaneous | 368 | 3.0 ± 1.4 | 61.0 | |||
| Instrumental | 27 | 3.8 ± 1.6 | 48.2 | |||
| Spontaneous | 0 | NA | NA | NA | ||
| Instrumental | 0 | NA | NA | NA | ||
Multiple logistic regression analysis.
Outcome: length of hospital stay (LoS) longer than ED benchmarks (2 days for spontaneous vaginal deliveries; 3 days for instrumental vaginal deliveries). Effect estimates for hospital and calendar year adjusted for all other factors. Adjusted odds ratios (aOR*) and population attributable risks (PAR1, PAR2,** PAR3, PAR4**) with 95% confidence intervals (95%CI). NA = Not available; observations = complete (case analysis) observations.
| FACTORS | STRATA | VAGINAL DELIVERY MODE | |||||
|---|---|---|---|---|---|---|---|
| SPONTANEOUS | INSTRUMENTAL | ||||||
| aOR (95%CI) | PAR1 (95%CI) | PAR2 (95%CI) | aOR (95%CI) | PAR3 (95%CI) | PAR4 (95%CI) | ||
| reference | reference | reference | reference | reference | reference | ||
| 89.38 (78.49; 101.78) | +64.5% (+63.4%; +65.6%) | +65.8% (+64.6%; +67.0%) | 7.90 (6.38; 9.78) | +44.8% (+41.0%; +48.5%) | +43.2% (+39.4%; +46.9%) | ||
| 4.86 (4.51; 5.23) | +37.5% (+35.9%; +39.0%) | +38.1% (+36.5%; +39.7%) | 0.83 (0.59; 1.17) | -0.0% (-5.2%; +4.3) | -0.3% (-4.3%; +3.7.%) | ||
| 26.47 (22.35; 31.46) | +59.0 (+57.5%; +60.6%) | +60.2% (+58.6%; +61.8%) | 7.85 (5.08; 12.12) | +44.7% (+35.1%; +53.4%) | +43.0 (+33.0%; +52.1%) | ||
| 8.40 (7.68; 9.19) | +46.7% (+45.1%; +48.2%) | +47.5 (+45.9%; +49.1%) | 2.21 (1.67; 2.94) | +16.1% (+10.7%; +21.5%) | +14.5% (+9.5%; +19.4%) | ||
| 2.93 (2.69; 3.20) | +27.4% (+25.6%; +29.3%) | +27.9% (+26.0%; +29.8%) | 0.79 (0.58; 1.08) | -1.1% (-5.2%; +3.1%) | -1.0 (-4.3%; +2.8%) | ||
| 0.77 (0.72; 0.83) | -1.0 (-2.2; +1.0%) | -1.0% (-2.1%; +1.0%) | 0.72 (0.56; 0.95) | -2.2% (-5.7%; +1.4%) | -1.7 (-4.7%; +1.3%) | ||
| 2.78 (2.61; 2.96) | +26.3% (+24.8; +27.7%) | +26.7% (+25.2%; +28.2%) | 1.53 (1.21; 1.94) | +9.0% (+5.0%; +13.0%) | +7.9% (+4.4%; +11.4%) | ||
| 10.42 (9.49; 11.44) | +49.7% (+48.2%; +51.2%) | +50.6% (+49.0%; +52.1%) | 2.85 (2.15; 3.78) | +21.5% (+15.8%; +27.1%) | +19.6% (+14.2%; +24.9%) | ||
| 2.39 (2.24; 2.55) | +23.1% (+21.6%; +24.6%) | +23.5% (+22.0%; +25.0%) | 2.56 (2.03; 3.23) | +19.2% (+14.8; +23.5%) | +17.3% (+13.4%; +21.3%) | ||
| 10.30 (9.45 11.21) | +49.5% (+48.1%; +51.0) | +50.4% (+48/9%; +51.9%) | 2.41 (1.88; 3.10) | +17.9% (+13.2%; +22.5%) | +16.1% (+11.8%; +20.4%) | ||
* Multiple logistic regression model adjusted for: Health care setting and time-frame factors (hospital and calendar year); Maternal health factors (mother’s age; hypertension/diabetes; amniocentesis; number of obstetric checks; number of ultrasound scans performed; labour induction; labour analgesia; neonatal status; presentation; pre-delivery LoS); Child’s fragility factors (Apgar score at 5 minutes; ICU admission; multiple birth); Child’s size factors (gestational age; birthweight; placenta weight); Obstetric history factors (parity; history of caesarean sections); Socio-demographic factors (father’s age; mother’s nationality; mother’s educational level)
$ Population Attributable Risk 1 (PAR 1) and 3 (PAR 3). Proportional variation of LoS < ED after childbirth in the ideal scenario each hospital would be performing as hospital A during calendar year 2015
** Population Attributable Risk 2 (PAR 2) and 4 (PAR4). Proportional variation of LoS < ED after childbirth in the ideal scenario each hospital would be performing as hospital A during calendar year 2015. Estimations of PAR2 and PAR4 calculated only for low risk pregnancies, defined as conditions of the mother and/or the newborn simultaneously meeting all the following criteria: for spontaneous vaginal deliveries (PAR 2): mother’s age<35; no resuscitation performed; child not admitted to ICU; singleton birth; Apgar score at 1 minute ≥7; Apgar score at 5 minutes ≥8; no labour induction; no women affected by hypertension/diabetes; birthweight: 2,500–3,999gr; gestational age: 37–40 weeks; pre delivery LoS <2 days; for instrumental vaginal deliveries (PAR 4): in addition to all above criteria, the calculation of PAR4 was restricted to women not administered with labour analgesia.