Correction to Hospital surgical volume–outcome relationship in caesarean hysterectomy for placenta accreta spectrum

IF 4.3 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Bjog-An International Journal of Obstetrics and Gynaecology Pub Date : 2023-12-12 DOI:10.1111/1471-0528.17728
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Abstract

Matsuo, K, Youssefzadeh, AC, Mandelbaum, RS, Sangara, RN, Matsuzaki, S, Matsushima, K, Klar, M, Ouzounian, JG, Wright, JD. Hospital surgical volume–outcome relationship in caesarean hysterectomy for placenta accreta spectrum. BJOG 2022; 129: 986–993. https://doi.org/10.1111/1471-0528.16993

The authors would like to correct the analytic approach in their investigation that assessed the association between hospital volume for caesarean hysterectomy and surgical morbidity in pregnant patients with placenta accreta spectrum. In the previous analysis, they calculated the relative hospital surgical volume as the summation of number of patients who had caesarean hysterectomy for placenta accreta spectrum over the 3-year study period by using the anonymized hospital classifiers. They would like to clarify that this analytic schema is to be corrected as the annualized number. In this annualized fashion, the relative hospital volume for caesarean hysterectomy was calculated in each year. The remaining patient-level analysis was unchanged.

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纠正剖腹产子宫切除术治疗胎盘植入谱系中的医院手术量-结果关系
Matsuo, K, Youssefzadeh, AC, Mandelbaum, RS, Sangara, RN, Matsuzaki, S, Matsushima, K, Klar, M, Ouzounian, JG, Wright, JD.剖腹产子宫切除术治疗胎盘早剥谱系中医院手术量与手术结果的关系。BJOG 2022; 129:https://doi.org/10.1111/1471-0528.16993The 作者希望纠正他们在评估剖腹产子宫切除术住院量与胎盘早剥孕妇手术发病率之间关系的调查中的分析方法。在之前的分析中,他们通过使用匿名医院分类器,将 3 年研究期间因胎盘早剥而进行剖腹产子宫切除术的患者人数相加,计算出相对医院手术量。他们希望澄清的是,这一分析模式应更正为年化数字。通过这种年化方式,计算出了每年剖腹产子宫切除术的相对医院数量。作者发现了以下错误:之前的图 1 不正确,根据修订后的剖腹产子宫切除术相对住院量计算的患者分布情况见下文更正后的图 1。研究中近三分之二的患者接受了剖腹产子宫切除术,而医院的相对手术量为每年 5 例。研究人群中有近 10% 的患者在相对手术量为每年 15 例或更多的中心接受了剖腹产子宫切除术。图中显示了加权模型中一年胎盘早剥谱的年化相对医院剖宫产手术量的分布。SV, 剖宫产子宫切除术的年化相对医院手术量。之前的图 2 有误,针对测量的手术发病率(预先定义为出血、凝血功能障碍、休克、尿路损伤和死亡),修订后的相对手术量切点分析结果显示在以下经更正的图 2 中。相对医院手术量在 25 例或以上时,手术发病率明显较低(56.7% 对 63.6%,P = 0.002)。在此基础上,研究人群中的患者被分为以下三组:2705 例(45.0%)患者在医院相对手术量为每年 5 例的中心进行了剖腹产子宫切除术(低手术量组);2820 例(46.9%)患者在医院相对手术量每年超过 5 例但少于 25 例的中心进行了剖腹产子宫切除术(中手术量组);485 例(8.1%)患者在医院相对手术量每年少于 25 例的中心进行了剖腹产子宫切除术(高手术量组)。图 2在图形浏览器中打开PowerPoint剖腹产子宫切除术医院相对手术量与手术发病率之间的关系。共测试了 11 个模型来检验剖宫产手术相对住院量与测量的手术结果(出血、休克、凝血功能障碍、尿路损伤和死亡)之间的关系:线性模型、对数模型、逆模型、二次模型、三次模型、幂模型、复合模型、S 模型、逻辑模型、增长模型和指数模型。在具有统计学意义的模型中,选择 p 值最小的模型进行分析(立方模型,p = 6 × 10-5)。以自动方式,通过立方曲线建模确定切点的反射点(≥25 例,p = 0.002)。根据所选模型,显示了每个切点的手术发病率。点代表观察值,条代表标准误差。所有分析均基于全国估算的加权模型。之前的表 1 有误,根据修订后的暴露分组得出的患者水平特征见下文更正后的表 1。与低剂量组的患者相比,中剂量组和高剂量组的患者更有可能患有内科合并症和更严重的胎盘植入谱。与低容量组的患者相比,中容量组和高容量组的患者也更有可能出现胎盘早剥,这是产前疑似病例的代名词。每个剖宫产子宫切除术量的患者人口统计学特征(多变量分析).CharacteristicLowMidHighMid vs. lowHigh vs. low(%)(%)(%)aOR (95%CI)aOR (95%CI)Age (years)34†34†33†1.01(1.00-1.02)0.97(0.95-0.99)*年份201632.031.425.81.00(参考)1.00(参考)201731.132.834.01.11(0.97-1.28)0.80(0.62-1.03)201837.035.840.21.15(1.00-1.32)0.79(0.61-1.03)种族/民族白43.139.233.01.00(参考)1.00(参考)黑15.519.722.71.33(1.13-1.58)*1.73(1.28-2.35)*西班牙裔24.425.527.81.37(1.17-1.60)*1.47(1.09-1.98)*亚洲人6.75.05.20.82(0.63-1.07)0.84(0.51-1.37)其他5.97.1a1.46(1.14-1.88)*0.46(0.23-0.
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来源期刊
CiteScore
10.90
自引率
5.20%
发文量
345
审稿时长
3-6 weeks
期刊介绍: BJOG is an editorially independent publication owned by the Royal College of Obstetricians and Gynaecologists (RCOG). The Journal publishes original, peer-reviewed work in all areas of obstetrics and gynaecology, including contraception, urogynaecology, fertility, oncology and clinical practice. Its aim is to publish the highest quality medical research in women''s health, worldwide.
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