| Influencia de las comorbilidades de la paciente sobre el riesgo de cuasiaccidentes sobre la morbilidad o la mortalidad materna. |
Influence of Patient Comorbidities on the Risk of Near-miss Maternal Morbidity or Mortality Mhyre, Jill M. M.D.; Bateman, Brian T. M.D.; Leffert, Lisa R. M.D. Anesthesiology November 2011 - Volume 115 - Issue 5 - p 963-972doi: 10.1097/ALN.0b013e318233042d Background: Maternal morbidity and mortality are increased in the United States compared with that of other developed countries. The objective of this investigation is to determine the extent to which it is possible to predict which patients will experience near-miss morbidity or mortality. Methods: The authors defined near-miss morbidity as end-organ injury associated with length of stay greater than the 99th percentile or discharge to a second medical facility, and identified all cases of near-miss morbidity or death from admissions for delivery in the 2003-2006 Nationwide Inpatient Sample. Logistic regression was used to examine the effect of maternal characteristics on rates of near-miss morbidity/mortality. Results: Approximately 1.3 per 1,000 hospitalizations for delivery was complicated by near-miss morbidity/mortality as defined in this study (95% CI 1.3-1.4). Most of these events (58.3%) occurred in 11.8% of the delivering population-in those women with important medical comorbidities or obstetric complications identified before admission for delivery. The highest rates were noted among women with pulmonary hypertension (98.0 cases per 1,000 deliveries), malignancy (23.4 per 1,000), and systemic lupus erythematosus (21.1 per 1,000). Conclusions: Risk for near-miss morbidity or mortality is substantially increased among an identifiable subset of pregnant women. To the extent that antepartum multidisciplinary coordination and high-quality intrapartum care improve delivery outcomes for women with significant antepartum medical and obstetric disease, then public health investments to reduce the national burden of delivery-related near-miss morbidity and mortality will have the greatest effect by focusing resources on identifying and serving these high-risk groups. http://journals.lww.com/anesthesiology/Fulltext/2011/11000/Influence
_of_Patient_Comorbidities_on_the_Risk_of.18.aspx
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| Modelo de proveedor de la anestesia, los recursos del hospital, y los resultados maternos. |
Anesthesia provider model, hospital resources, and maternal outcomes. Needleman J, Minnick AF. Department of Health Services, UCLA School of Public Health, Los Angeles, CA, USA. Health Serv Res. 2009 Apr;44(2 Pt 1):464-82. Epub 2008 Nov 4. Abstract OBJECTIVE: Determine the ability of anesthesia provider model and hospital resources to explain maternal outcome variation. DATA SOURCE/STUDY SETTING: 1,141,641 obstetrical patients from 369 hospitals that reported at least one live birth in 2002 in six representative states. STUDY DESIGN: Logistic regression of death, anesthesia complication, nonanesthesia maternal complication, and obstetrical trauma for all patients and those having cesarean deliveries on anesthesia provider model, obstetrical and anesthesia, and patient variables. DATA COLLECTION/EXTRACTION METHODS: Data was assembled from information given by hospitals to state agencies and from a 2004 survey of obstetrical organization resources. PRINCIPAL FINDINGS: Anesthesia complication rates in anesthesiologist-only hospitals were 0.27 percent compared with 0.23 percent in certified registered nurse anesthetist (CRNA) only hospitals. Rates among other provider models varied from 0.24 to 0.37 percent with none statistically different from the anesthesiologist-only hospitals. A similar pattern was observed for rates of other outcomes. Multivariate analysis found no systematic differences between hospitals with anesthesiologist-only models and models using CRNAs. There was no consistent pattern of association of other hospital or patient characteristics with outcomes. CONCLUSION: Hospitals that use only CRNAs, or a combination of CRNAs and anesthesiologists, do not have systematically poorer maternal outcomes compared with hospitals using anesthesiologist-only models. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677049/pdf/hesr0044-0464.pdf |
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