1
|
Piffer S, Pedron M, Rizzello R, Orrasch M, Zambotti F, Zardini S. Prevalence of gestational diabetes and recourse to postpartum oral glucose tolerance test in the Autonomous Province of Trento (Italy). Eur J Obstet Gynecol Reprod Biol 2023; 282:50-54. [PMID: 36634406 DOI: 10.1016/j.ejogrb.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 12/01/2022] [Accepted: 12/26/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The occurrence of gestational diabetes (GDM) is increasing worldwide, and such a diagnosis is important for women's health beyond pregnancy. Therefore, many guidelines suggest the re-evaluation of glucose tolerance with a postpartum oral glucose tolerance test (OGTT) in women with GDM. This study reports the prevalence of GDM and the use of a postpartum OGTT in women assisted at maternity units in the Autonomous Province of Trento in the years 2017-2018, investigating the socio-demographic and health-care variables that can facilitate access to the test. STUDY DESIGN For the diagnosis of GDM, the International Association of Diabetes and Pregnancy Study Group criteria were used. The Birth Assistance Certificate and the Hospital Information System were used to retrieve clinical and socio-demographic data. Univariate and multivariate analyses were performed to evaluate the stratification of the use of a postpartum OGTT. RESULTS In total, 8,308 pregnant women were assisted at the maternity units in Trento. There were 532 recorded cases of GDM (266 cases per year) and the overall average prevalence was 6.4 % (95 % CI, 5.90-6.90), 4.9 % of whom were Italian (95 % CI, 4.38-5.42) and 10.4 %, foreigners (95 % CI, 9.13-11.67). 135 women diagnosed with GDM and residing in Trento out of 513 were evaluated using a postpartum OGTT (26.3%, CI 95% 22.50-30.10), with pathological results in 61 cases (45.2%). In the multivariate analyses, insulin therapy during pregnancy, delivery at a third-level birth point, and a discharge letter informing of the presence of GDM and of the need for a postpartum OGTT were independent factors associated with the probability of carrying out a postpartum OGTT. CONCLUSIONS The prevalence of GDM in our study is lower than in previous Italian studies; however, it is consistent with European data. The proportion of women who were assessed using the postpartum OGTT is lower than that reported by previous studies. The health-care factors seem predominant among the socio-demographic characteristics of the cases in influencing access to the test. The awareness of women, the sharing of guidelines among the different sectors of the health system, and an optimal management of the discharge from the birth point are critical in ensuring an optimal follow-up in women with GDM.
Collapse
Affiliation(s)
- Silvano Piffer
- Clinical and Evaluative Epidemiology Service, Provincial Health Agency, Trento, Italy.
| | - Mariangela Pedron
- Clinical and Evaluative Epidemiology Service, Provincial Health Agency, Trento, Italy.
| | - Roberto Rizzello
- Clinical and Evaluative Epidemiology Service, Provincial Health Agency, Trento, Italy.
| | - Massimo Orrasch
- Diabetes Care Center, Provincial Health Agency, Trento, Italy.
| | | | - Sara Zardini
- Obstetrics and Gynecology Unit, Trento S. Chiara Hospital, Provincial Health Agency, Trento, Italy.
| |
Collapse
|
2
|
Cegolon L, Mastrangelo G, Maso G, Pozzo GD, Heymann WC, Ronfani L, Barbone F. Determinants of length of stay after cesarean sections in the Friuli Venezia Giulia Region (North-Eastern Italy), 2005-2015. Sci Rep 2020; 10:19238. [PMID: 33159096 PMCID: PMC7648096 DOI: 10.1038/s41598-020-74161-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
Since Italy has the highest cesarean section (CS) rate (38.1%) among all European countries, the containment of health care costs associated with CS is needed, along with control of length of hospital stay (LOS) following CS. This population based cross-sectional study aims to investigate LoS post CS (overall CS, OCS; planned CS, PCS; urgent/emergency CS, UCS), in Friuli Venezia Giulia (a region of North-Eastern Italy) during 2005-2015, adjusting for a considerable number factors, including various obstetric conditions/complications. Maternal and newborn characteristics (health care setting and timeframe; maternal health factors; child's size factors; child's fragility factors; socio-demographic background; obstetric history; obstetric conditions) were used as independent variables. LoS (post OCS, PCS, UCS) was the outcome measure. The statistical analysis was conducted with multivariable linear (LoS expressed as adjusted mean, in days) as well as logistic (adjusted proportion of LoS > 4 days vs. LoS ≤ 4 days, using a 4 day cutoff for early discharge, ED) regression. An important decreasing trend over time in mean LoS and LoS > ED was observed for both PCS and UCS. LoS post CS was shorter with parity and history of CS, whereas it was longer among non-EU mothers. Several obstetric conditions/complications were associated with extended LoS. Whilst eclampsia/pre-eclampsia and preterm gestations (33-36 weeks) were predominantly associated with longer LoS post UCS, for PCS LoS was significantly longer with birthweight 2.0-2.5 kg, multiple birth and increasing maternal age. Strong significant inter-hospital variation remained after adjustment for the major clinical conditions. This study shows that routinely collected administrative data provide useful information for health planning and monitoring, identifying inter-hospital differences that could be targeted by policy interventions aimed at improving the efficiency of obstetric care. The important decreasing trend over time of LoS post CS, coupled with the impact of some socio-demographic and obstetric history factors on LoS, seemingly suggests a positive approach of health care providers of FVG in decision making on hospitalization length post CS. However, the significant role of several obstetric conditions did not influence hospital variation. Inter-hospital variations of LoS could depend on a number of factors, including the capacity to discharge patients into the surrounding non-acute facilities. Further studies are warranted to ascertain whether LoS can be attributed to hospital efficiency rather than the characteristics of the hospital catchment area.
Collapse
Affiliation(s)
- L Cegolon
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy.
- Local Health Unit N. 2 "Marca Trevigiana", Public Health Department, Via Castellana 2, 31100, Treviso, Italy.
| | - G Mastrangelo
- Department of Cardio-Thoracic and Vascular Sciences & Public Health, Padua University, Padua, Italy
| | - G Maso
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - G Dal Pozzo
- Obstetrics and Gynecology Unit, Hospital "Villa Salus, Venice, Italy
| | - W C Heymann
- Florida Department of Health, Sarasota County Health Department, Sarasota, FL, USA
- Department of Clinical Sciences, College of Medicine, Florida State University, Sarasota, FL, USA
| | - L Ronfani
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - F Barbone
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| |
Collapse
|
3
|
Isayama T, O'Reilly D, Beyene J, Shah PS, Lee SK, McDonald SD. Hospital Care Cost and Resource Use of Early Discharge of Healthy Late Preterm and Term Singletons: A Population-based Cohort Study and Cost Analysis. J Pediatr 2020; 226:96-105.e7. [PMID: 32610167 DOI: 10.1016/j.jpeds.2020.06.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/12/2020] [Accepted: 06/19/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the hospital care cost and resource use associated with discharge timings after late preterm and term births. STUDY DESIGN This population-based cohort study and cost analysis included all healthy singleton late preterm (35-36 weeks gestational age) and term infants (37-41 weeks gestational age) born vaginally in hospitals in Ontario, Canada, from 2003 to 2012. Early, late, and very late discharge (<48, 48-71, and 72-95 hours after birth, respectively) were compared using generalized linear models. The primary outcome was the total hospital care cost (hospitalizations and emergency department visits) per infant within 28 days of birth. RESULTS Among 860 693 singletons (3.7% late preterm), early discharge increased significantly over 10 years for term infants (from 69% to 82%; P < .001), but not late preterm infants (from 32% to 35%; P = .75). The mean total cost within 28 days after birth was not significantly different for late preterm infants between early discharge and late discharge after adjustment. However, for term infants, the adjusted cost was higher with early discharge than late discharge (aMCD $311 [95% CI, $211-$412] per infant; $366 [95% CI, $355-$377] per mother-infant dyad). The neonatal readmission rates were higher after early than late discharge for late preterm and term infants. CONCLUSIONS Early discharge was not associated with cost savings for vaginally born healthy singleton late preterm infants, and instead was associated with a cost increase for term infants. Early discharge was associated with higher neonatal readmission rates. Individualized approach balancing the risk and benefit is appropriate to determine the discharge timings.
Collapse
Affiliation(s)
- Tetsuya Isayama
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Newborn and Developmental Pediatrics, Sunnybrook Health Science Centre, Toronto, Ontario, Canada; Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan.
| | - Daria O'Reilly
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Prakesh S Shah
- Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Shoo K Lee
- Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sarah D McDonald
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada; Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
4
|
Kruse AR, Arendt LH, Jakobsen DH, Kehlet H, Lauszus FF, Forman A, Uldbjerg N, Sundtoft IB, Kesmodel US. Length of hospital stay after cesarean section in Denmark from 2004 to 2016: A national register-based study. Acta Obstet Gynecol Scand 2020; 100:244-251. [PMID: 32979215 DOI: 10.1111/aogs.14000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Length of hospital stay after birth has decreased during the last decades, but nationwide data on length of hospital stay after cesarean section are lacking. Elements of Enhanced Recovery Programs were reported to reduce the length of hospital stay. The aim of this nationwide study was to describe the length of hospital stay after cesarean section in Denmark from 2004 to 2016 taking into account birth- and health-related factors as well as demographic changes and, further, to assess potential differences between the five Danish regions. MATERIAL AND METHODS Length of hospital stay was assessed in 164 209 deliveries by cesarean section in Denmark from 2004 to 2016. Data were obtained from the Danish National Patient Register. All deliveries by cesarean section at gestational age <22 weeks were excluded. Median length of hospital stay was reported based on crude and adjusted analyses. RESULTS The median length of hospital stay was significantly reduced by 39 hours (95% confidence interval [CI] 37.9-40.1), from 97 hours (4.0 days) in 2004 to 58 hours (2.4 days) in 2016. Reductions were observed among both planned and emergency cesarean sections. When birth- and health-related factors as well as demographic changes were accounted for, median length of hospital stay was reduced by 30 hours (95% CI 29.3-30.8) in the period. The decrease in length of hospital stay from 2004 to 2016 varied between the five Danish regions, with adjusted reductions between 19 and 46 hours. CONCLUSIONS A nationwide decrease in length of hospital stay after cesarean section was observed from 2004 to 2016 across all five regions but with significant regional variations. Further studies on the optimal length of hospital stay are needed, especially with regard to implementation of enhanced recovery programs.
Collapse
Affiliation(s)
- Anne R Kruse
- Department of Obstetrics and Gynecology, Regional Hospital West Jutland, Herning, Denmark
| | - Linn H Arendt
- Department of Obstetrics and Gynecology, Regional Hospital Horsens, Horsens, Denmark
| | | | - Henrik Kehlet
- Surgical Pathophysiology Unit, Rigshospitalet, Copenhagen, Denmark
| | - Finn F Lauszus
- Department of Obstetrics and Gynecology, Regional Hospital West Jutland, Herning, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Iben B Sundtoft
- Department of Obstetrics and Gynecology, Regional Hospital West Jutland, Herning, Denmark
| | - Ulrik S Kesmodel
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
5
|
Cegolon L, Maso G, Heymann WC, Bortolotto M, Cegolon A, Mastrangelo G. Determinants of Length of Stay After Vaginal Deliveries in the Friuli Venezia Giulia Region (North-Eastern Italy), 2005-2015. Sci Rep 2020; 10:5912. [PMID: 32249795 PMCID: PMC7136236 DOI: 10.1038/s41598-020-62774-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 03/19/2020] [Indexed: 11/28/2022] Open
Abstract
Although length of stay (LoS) after childbirth has been diminishing in several high-income countries in recent decades, the evidence on the impact of early discharge (ED) on healthy mothers and term newborns after vaginal deliveries (VD) is still inconclusive and little is known on the characteristics of those discharged early. We conducted a population-based study in Friuli Venezia Giulia (FVG) during 2005-2015, to investigate the mean LoS and the percentage of LoS longer than our proposed ED benchmarks following VD: 2 days after spontaneous vaginal deliveries (SVD) and 3 days post instrumental vaginal deliveries (IVD). We employed a multivariable logistic as well as a linear regression model, adjusting for a considerable number of factors pertaining to health-care setting and timeframe, maternal health factors, newborn clinical factors, obstetric history factors, socio-demographic background and present obstetric conditions. Results were expressed as odds ratios (OR) and regression coefficients (RC) with 95% confidence interval (95%CI). The adjusted mean LoS was calculated by level of pregnancy risk (high vs. low). Due to a very high number of multiple tests performed we employed the procedure proposed by Benjamini-Hochberg (BH) as a further selection criterion to calculate the BH p-value for the respective estimates. During 2005-2015, the average LoS in FVG was 2.9 and 3.3 days after SVD and IVD respectively, and the pooled regional proportion of LoS > ED was 64.4% for SVD and 32.0% for IVD. The variation of LoS across calendar years was marginal for both vaginal delivery modes (VDM). The adjusted mean LoS was higher in IVD than SVD, and although a decline of LoS > ED and mean LoS over time was observed for both VDM, there was little variation of the adjusted mean LoS by nationality of the woman and by level of pregnancy risk (high vs. low). By contrast, the adjusted figures for hospitals with shortest (centres A and G) and longest (centre B) mean LoS were 2.3 and 3.4 days respectively, among "low risk" pregnancies. The corresponding figures for "high risk" pregnancies were 2.5 days for centre A/G and 3.6 days for centre B. Therefore, the shift from "low" to "high" risk pregnancies in all three latter centres (A, B and G) increased the mean adjusted LoS just by 0.2 days. By contrast, the discrepancy between maternity centres with highest and lowest adjusted mean LoS post SVD (hospital B vs. A/G) was 1.1 days both among "low risk" (1.1 = 3.4-2.3 days) and "high risk" (1.1 = 3.6-2.5) pregnanices. Similar patterns were obseved also for IVD. Our adjusted regression models confirmed that maternity centres were the main explanatory factor for LoS after childbirth in both VDM. Therefore, health and clinical factors were less influential than practice patterns in determining LoS after VD. Hospitalization and discharge policies following childbirth in FVG should follow standardized guidelines, to be enforced at hospital level. Any prolonged LoS post VD (LoS > ED) should be reviewed and audited if need be. Primary care services within the catchment areas of the maternity centres of FVG should be improved to implement the follow up of puerperae undergoing ED after VD.
Collapse
Affiliation(s)
- L Cegolon
- Local Health Unit N.2 "Marca Trevigiana", Public Health Department, Veneto Region, Treviso, Italy.
- Institute for Maternal & Child Health, IRCCS "Burlo Garofolo", Trieste, Italy.
| | - G Maso
- Local Health Unit N.2 "Marca Trevigiana", Public Health Department, Veneto Region, Treviso, Italy
| | - W C Heymann
- Florida State University, Department of Clinical Sciences, College of Medicine, Sarasota, Florida, USA
- Florida Department of Health, Sarasota County Health Department, Sarasota, Florida, USA
| | - M Bortolotto
- Padua University, FISPPA Department, Padua, Italy
| | - A Cegolon
- University of Macerata, Department of Political, Social & International Relationships, Macerata, Italy
| | - G Mastrangelo
- Padua University, Department of Cardio-Thoracic & Vascular Sciences, Padua, Italy
| |
Collapse
|
6
|
Cegolon L, Campbell O, Alberico S, Montico M, Mastrangelo G, Monasta L, Ronfani L, Barbone F. Length of stay following vaginal deliveries: A population based study in the Friuli Venezia Giulia region (North-Eastern Italy), 2005-2015. PLoS One 2019; 14:e0204919. [PMID: 30605470 PMCID: PMC6317786 DOI: 10.1371/journal.pone.0204919] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 09/17/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lengths of hospital stay (LoS) after childbirth that are too long have a number of health, social and economic drawbacks. For this reason, in several high-income countries LoS has been reduced over the past decades and early discharge (ED) is increasingly applied to low-risk mothers and newborns. METHODS We conducted a population-based study investigating LoS after chilbirth across all 12 maternity centres of Friuli Venezia-Giulia (FVG), North-Eastern Italy, using a database capturing all registered births in the region from 2005 to 2015 (11 years). Adjusting for clinical factors (clinical conditions of the mother and the newborn), socio-demographic bakground and obstetric history with multivariable logistic regression, we ranked facility centres for LoS that were longer than our proposed ED benchmarks (defined as >2 days for spontaneous vaginal deliveries and >3 days for instrumental vaginal deliveries). The reference was hospital A, a national excellence centre for maternal and child health. RESULTS The total number of births examined in our database was 109,550, of which 109,257 occurred in hospitals. During these 11 years, the number of births significantly diminished over time, and the pooled mean LoS for spontaneous vaginal deliveries in the whole FVG was 2.9 days. There was a significantly decreasing trend in the proportion of women remaining admitted more than the respective ED cutoffs for both delivery modes. The percentage of women staying longer that the ED benchmarks varied extensively by facility centre, ranging from 32% to 97% for spontaneous vaginal deliveries and 15% to 64% for instrumental vaginal deliveries. All hospitals but G were by far more likely to surpass the ED cutoff for spontaneous deliveries. As compared with hospital A, the most significant adjusted ORs for LoS overcoming the ED thresholds for spontaneous vaginal deliveries were: 89.38 (78.49-101.78); 26.47 (22.35-31.36); 10.42 (9.49-11.44); 10.30 (9.45-11.21) and 8.40 (7.68-9.19) for centres B, D, I, K and E respectively. By contrast the OR was 0.77 (95%CI: 0.72-0.83) for centre G. Similar mitigated patterns were observed also for instrumental vaginal deliveiries. CONCLUSIONS For spontaneous vaginal deliveries the mean LoS in the whole FVG was shorter than 3.4 days, the average figure most recently reported for the whole of Italy, but higher than other countries' with health systems similar to Italy's. Since our results are controlled for the effect of all other factors, the between-hospital variability we found is likely attributable to the health care provider itself. It can be argued that some maternity centres of FVG may have had ecocomic interest in longer LoS after childbirth, although fear of medico-legal backlashes, internal organizational malfunctions of hospitals and scarce attention of ward staff on performance efficiency shall not be ruled out. It would be therefore important to ensure higher level of coordination between the various maternity services of FVG, which should follow standardized protocols to pursue efficiency of care and allow comparability of health outcomes and costs among them. Improving the performance of FVG and Italian hospitals requires investment in primary care services.
Collapse
Affiliation(s)
- Luca Cegolon
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Scientific Directorate, Trieste, Italy
- * E-mail: ,
| | - Oona Campbell
- London School of Hygiene & Tropical Medicine, MARCH Centre, Faculty of Epidemiology & Population Health, London, United Kingdom
| | - Salvatore Alberico
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Clinical Epidemiology & Public Health Research Unit, Trieste, Italy
| | - Marcella Montico
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Clinical Epidemiology & Public Health Research Unit, Trieste, Italy
| | - Giuseppe Mastrangelo
- Padua University, Department of Cardio-Thoracic & Vascular Sciences, Padua, Italy
| | - Lorenzo Monasta
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Clinical Epidemiology & Public Health Research Unit, Trieste, Italy
| | - Luca Ronfani
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Clinical Epidemiology & Public Health Research Unit, Trieste, Italy
| | - Fabio Barbone
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Scientific Directorate, Trieste, Italy
| |
Collapse
|