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Noiret B, Lenne X, Bruandet A, Piessen G, Eveno C. Should Cytoreductive Surgery Alone for Peritoneal Metastases of Colorectal Origin be Centralized? A National Study of 4159 Procedures. Ann Surg Oncol 2024; 31:6220-6227. [PMID: 38549002 DOI: 10.1245/s10434-024-15180-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/01/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Addition of oxaliplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery (CRS) in the treatment of peritoneal metastases of colorectal origin (CRPM) did not show any survival benefit in the PRODIGE 7 trial (P7). This study aimed to investigate whether perioperative outcomes after CRS alone for CRPM patients is mediated by hospital volume and to determine the effect of P7 on French practice for CRPM patients treated respectively with CRS alone and CRS/HIPEC. METHODS Data from CRPM patients treated with CRS alone between 2013 and 2020 in France were collected through a national medical database. The study used a cutoff value of the annual CRS-alone caseload affecting the 90-day postoperative mortality (POM) determined from our previous study to define low-volume (LV) HIPEC and high-volume (HV) HIPEC centers. Perioperative outcomes were compared between no-HIPEC, LV-HIPEC, and HV-HIPEC centers. The trend between years and HIPEC rates was analyzed using the Cochrane-Armitage test. RESULTS Data from 4159 procedures were analyzed. The patients treated in no-HIPEC and LV-HIPEC centers were older compared with HV-HIPEC centers (p < 0.0001) and had a higher Elixhauser comorbidity index (p < 0.0001) and less complex surgery (p < 0.0001). Whereas the major morbidity (MM) rate did not differ between groups (p = 0.79), the 90-day POM was lower in HV-HIPEC centers than in no-HIPEC and LV-HIPEC centers (5.4% vs 15% and 13.3%; p < 0.0001), with lower failure-to-rescue (FTR) (p < 0.0001). After P7, the CRS/HIPEC rate decreased drastically in Cancer centers (p < 0.001), whereas patients treated with CRS alone are still referred to expert centers. CONCLUSIONS Centralization of CRS alone should improve patient selection as well as FTR and POM. After P7, CRS/HIPEC decreased mostly in Cancer centers, without any impact on the number of CRS-alone cases referred to expert centers.
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Affiliation(s)
- Barbara Noiret
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - Xavier Lenne
- Department of Medical Information, Lille University Hospital, Lille, France
| | - Amélie Bruandet
- Department of Medical Information, Lille University Hospital, Lille, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
- UMR-S1277-CANTHER "Cancer Heterogeneity, Plasticity and Resistance to Therapies" Laboratory, Lille, France
| | - Clarisse Eveno
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France.
- UMR-S1277-CANTHER "Cancer Heterogeneity, Plasticity and Resistance to Therapies" Laboratory, Lille, France.
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Bitterlin T, Valibouze C, Lenne X, Bruandet A, Desreumaux P, Zerbib P. Hospital Surgical Volume-Outcome Relationship of Postoperative Morbidity for Ileocolic Resection in Crohn's Disease: A French Nationwide Study of 4205 Patients. J Crohns Colitis 2024; 18:1071-1080. [PMID: 38243563 DOI: 10.1093/ecco-jcc/jjae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND AND AIMS Despite the development of medical therapy, nearly 50% of patients with Crohn's disease [CD] undergo surgery during their lifetime. Several studies have suggested some risk factors for postoperative morbidity [POM] after ileocolic resection [ICR]. However, the impact of surgical hospital volume on POM in CD has not been extensively studied. This study aimed to assess the impact of surgical hospital volume on POM after ICR for CD. METHODS All patients with CD who underwent ICR in France between 2013 and 2022 were identified in the French Database, Programme de Médicalisation des Systèmes d'Information. Using the Chi-square automatic interaction detector, we determined the cut-off value to split high-surgical-volume [≥6 ICRs/year] and low-surgical-volume centres [<6 ICRs/year]. The primary outcome was the evaluation of major POM during hospitalization. POM was evaluated according to the surgical volume centre. The Elixhauser comorbidity index [ECI] was used to categorize the comorbidities of patients. RESULTS A total of 4205 patients were identified, and the major POM during hospitalization was significantly [p = 0.0004] lower in the high-surgical-volume [6.2%] compared to low-surgical-volume centres [9.1%]. After multivariate analysis, independent factors associated with major POM were surgical hospital volume [p = 0.024], male sex [p = 0.029], ECI ≥ 1 [p < 0.001], and minor POM [p < 0.001]. CONCLUSION Major POM after ICR for CD is closely associated with surgical hospital volume. Centralization of surgery for CD is desirable, especially in patients with major comorbidities.
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Affiliation(s)
- Thibaut Bitterlin
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France
| | - Caroline Valibouze
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France
| | - Xavier Lenne
- Medical Information Department, Lille University Hospital, Lille, France
| | - Amélie Bruandet
- Medical Information Department, Lille University Hospital, Lille, France
| | - Pierre Desreumaux
- Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille University Hospital, Lille, France
| | - Philippe Zerbib
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France
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Challine A, Kirouani M, Markar SR, Tzedakis S, Jaquet R, Piessen G, Dabakoyo-Yonli TS, Lefèvre JH, Lazzati A, Voron T. MIRO study: Do the results of a randomized controlled trial apply in a real population? Surgery 2024; 175:1055-1062. [PMID: 38490752 DOI: 10.1016/j.surg.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/04/2023] [Accepted: 11/26/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND The aim of our study was to evaluate the external validity of the MIRO randomized controlled trial findings in a similar nationwide setting "real life" population, especially the benefit of a hybrid approach in esophageal resection for pulmonary complication. The external validity of randomized controlled trial findings to the general population with the same condition remains problematic because of the inherent selection bias and rigid inclusion criteria. METHODS This study was a cohort study from a National Health Database (Programme de Medicalisation des Systemes d'Informations) between 2010 and 2022. All adult patients operated on using Ivor Lewis resection for esophageal cancer were included. We first validated the detection algorithm of postoperative complications in the health database. Then, we assessed the primary outcome, which was the comparison of postoperative severe pulmonary complications, leak rate, and 30-day mortality between the 2 surgical approaches (hybrid versus open) over a decade. RESULTS Between 2010 and 2012, 162 of 205 patients in the MIRO trial were anonymously identified in the health care database. No difference between randomized controlled trials and healthcare database measurements was found within severe respiratory complications (24% vs 22%, respectively) nor within leak rate (10% vs 9%, respectively). After application of selection criteria according to the MIRO trial, 3,852 patients were included between 2013 and 2022. The hybrid approach was a protective factor against respiratory complications after adjustment for confounding variables (odds ratio = 0.83; 95% confidence interval = 0.71-0.98, P = .025). No significant difference in the 30-day mortality rate or 30-day leakage rate between the types of approach was reported. CONCLUSION This national cohort study demonstrates the external validity of the MIRO randomized controlled trial findings in a real-life population within France.
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Affiliation(s)
- Alexandre Challine
- Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France; HeKA, Inria, Paris, France; Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France.
| | - Mehdi Kirouani
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Sheraz R Markar
- Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom
| | | | | | - Guillaume Piessen
- CHU Lille, Department of Digestive and Oncological Surgery, F-59000 Lille, France; Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000 Lille, France
| | | | - Jérémie H Lefèvre
- Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Andrea Lazzati
- HeKA, Inria, Paris, France; Service de chirurgie digestive et bariatrique, Centre intercommunal de Créteil, Créteil, France
| | - Thibault Voron
- Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
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Marchese U, Desbiens JF, Lenne X, Naveendran G, Tzedakis S, Gaillard M, Bruandet A, Theis D, Boyer L, Truant S, Fuks D, El Amrani M. Study of Risk Factors for Readmission After Pancreatectomy for Cancer: Analysis of Nationwide Cohort. Ann Surg 2024; 279:486-492. [PMID: 37254769 DOI: 10.1097/sla.0000000000005929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To identify the factors associated with readmission after pancreatectomy for cancer and to assess their impact on the 1-year mortality in a French multicentric population. BACKGROUND Pancreatectomy is a complex procedure with high morbidity that increases the length of hospital stay and jeopardizes survival. Hospital readmissions lead to increased health system costs, making this a topic of great interest. METHODS Data collected from patients who underwent pancreatectomy for cancer between 2011 and 2019 were extracted from a French national medico-administrative database. A descriptive analysis was conducted to evaluate the association of baseline variables, including age, sex, liver-related comorbidities, Charlson Comorbidity Index, tumor localization, and use of neoadjuvant therapy, along with hospital type and volume, with readmission status. Centers were divided into low and high volumes according to the cutoff of 26 cases/year. Logistic regression models were developed to determine whether the identified bivariate associations persisted after adjusting for the patient characteristics. The mortality rates during readmission and at 1 year postoperatively were also determined. RESULTS Of 22,935 patients who underwent pancreatectomy, 9129 (39.3%) were readmitted within 6 months. Readmission rates by year did not vary over the study period, and mean readmissions occurred within 20 days after discharge. Multivariate analysis showed that male sex [odds ratio (OR) = 1.12], age >70 years (OR = 1.16), comorbidities (OR = 1.21), distal pancreatectomy (OR = 1.11), and major postoperative complications (OR = 1.37) were predictors of readmission. Interestingly, readmission and surgery in low-volume centers increased the risk of death at 1 year by a factor of 2.15 [(2.01-2.31), P < 0.001] and 1.31 [(1.17-1.47), P < 0.001], respectively. CONCLUSIONS Readmission after pancreatectomy for cancer is high with an increased rate of 1-year mortality.
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Affiliation(s)
- Ugo Marchese
- Department of Digestive, HPB and Endocrine Surgery, Cochin Hospital, AP-HP Centre, Paris
- Paris University - 15 rue de l'école de médecine, Paris
| | - Jean-François Desbiens
- Department of digestive surgery and Transplantation, CHRU de Lille, Lille
- Lille university, Lille
| | - Xavier Lenne
- Lille university, Lille
- Department of Medical Information, CHRU de Lille, Lille
| | - Gaanan Naveendran
- Department of Digestive, HPB and Endocrine Surgery, Cochin Hospital, AP-HP Centre, Paris
- Paris University - 15 rue de l'école de médecine, Paris
| | - Stylianos Tzedakis
- Department of Digestive, HPB and Endocrine Surgery, Cochin Hospital, AP-HP Centre, Paris
- Paris University - 15 rue de l'école de médecine, Paris
| | - Martin Gaillard
- Department of Digestive, HPB and Endocrine Surgery, Cochin Hospital, AP-HP Centre, Paris
- Paris University - 15 rue de l'école de médecine, Paris
| | - Amelie Bruandet
- Lille university, Lille
- Department of Medical Information, CHRU de Lille, Lille
| | - Didier Theis
- Lille university, Lille
- Department of Medical Information, CHRU de Lille, Lille
| | - Laurent Boyer
- Department of Medical Information La Timone Hospital, Marseille
- Aix-Marseille University, Jardin du Pharo, Marseille
| | - Stephanie Truant
- Department of digestive surgery and Transplantation, CHRU de Lille, Lille
- Lille university, Lille
| | - David Fuks
- Department of Digestive, HPB and Endocrine Surgery, Cochin Hospital, AP-HP Centre, Paris
- Paris University - 15 rue de l'école de médecine, Paris
| | - Mehdi El Amrani
- Department of digestive surgery and Transplantation, CHRU de Lille, Lille
- Lille university, Lille
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Bruckner TA, Huo S, Fresson J, Zeitlin J. Preterm births among male and female conception cohorts in France during initial COVID-19 societal restrictions. Ann Epidemiol 2024; 91:58-64. [PMID: 38280410 DOI: 10.1016/j.annepidem.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/22/2023] [Accepted: 01/23/2024] [Indexed: 01/29/2024]
Abstract
PURPOSE A recent meta-analysis finds reduced risk of preterm birth (PTB; <37 weeks gestational age) during the initial stage of COVID-19 in which infection rates remained relatively low but many societies imposed restrictions on movement. None of this work, however, examines sex-specific responses despite much literature on other ambient "shocks" which would predict male sensitivity. We use a conception cohort approach to explore potential sex-specific PTB responses in France, a country which imposed a lockdown in Spring 2020. METHODS We applied interrupted time series methods using national data in France for 207 weeks among 1403,284 males and 1341,359 females conceived from 19 Jan 2016 to 6 Jan 2020. RESULTS For males in utero, the 1st COVID-19 societal lockdown corresponds with a - 0.60 per 100 conception reduction in PTB cases per week, for 12 consecutive weeks (95% confidence interval [CI]: -.36, -.84). For females in utero, the PTB reduction is smaller (-0.40 reduction per 100 conceptions, for 10 consecutive weeks, 95% CI: -.15, -.61). A formal test of sex differences in the PTB response indicates a stronger reduction in male (vs. female) PTB during the lockdown (p = .001). CONCLUSIONS Explanations for the counterintuitive reduction in PTB during COVID-19 among cohorts in utero during Spring 2020 should consider mechanisms that disproportionately affect males.
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Affiliation(s)
- Tim A Bruckner
- Center for Population, Inequality and Policy, University of California, Irvine, Irvine, CA, USA; Program in Public Health University of California, Irvine, Irvine, CA, USA.
| | - Shutong Huo
- Program in Public Health University of California, Irvine, Irvine, CA, USA
| | - Jeanne Fresson
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; University Hospital (CHRU), Nancy, France, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
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Ego A, Debillon T, Sourd D, Mitton N, Fresson J, Zeitlin J. Identifying Newborns with Hypoxic-Ischemic Encephalopathy in Hospital Discharge Data: A Validation Study. J Pediatr 2024; 268:113950. [PMID: 38336200 DOI: 10.1016/j.jpeds.2024.113950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/18/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
Hospital discharge databases (HDDs) are increasingly used for research on health of newborns. Linkage between a French population-based cohort of newborns with hypoxic-ischemic encephalopathy (HIE) and national HDD showed that the HIE ICD-10 code was not accurately reported. Our results suggest that HDD should not be used for research on neonatal HIE without prior validation of HIE ICD-10 codes.
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Affiliation(s)
- Anne Ego
- Public Health Department CHU Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP∗, TIMC-IMAG, Grenoble, France, ∗Institute of Engineering Univ, Grenoble Alpes; INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA, Paris Descartes University, Paris, France; Univ. Grenoble Alpes, Inserm CIC1406, CHU de Grenoble, Grenoble, France.
| | - T Debillon
- Department of Neonatology CHU Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP∗, TIMC-IMAG, Grenoble, France, ∗Institute of Engineering Univ, Grenoble Alpes
| | - D Sourd
- Public Health Department CHU Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP∗, TIMC-IMAG, Grenoble, France, ∗Institute of Engineering Univ, Grenoble Alpes
| | - N Mitton
- Department of Bioinformatics CHU Grenoble Alpes, Univ. Grenoble Alpes, Grenoble, France
| | - J Fresson
- Population Health Office, DREES, Paris, France
| | - J Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA, Paris Descartes University, Paris, France
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Pina Vegas L, Drouin J, Weill A, Dray-Spira R. Pregnancy outcomes in women with rheumatoid arthritis: an 11-year French nationwide study. RMD Open 2024; 10:e003762. [PMID: 38242551 PMCID: PMC10806509 DOI: 10.1136/rmdopen-2023-003762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) can affect women of childbearing age. The management of patients with RA during pregnancy has evolved over the past decades, especially with the availability of new therapeutic molecules. OBJECTIVES To describe pregnancy in women with RA, to compare pregnancy outcomes with those of women in the general population and to compare pregnancy outcomes in women with active and inactive RA. METHODS Using the French National Health Data System, we identified all pregnancies ending between 2010 and 2020 in patients with and without RA. Characteristics were described. Active RA was defined by conventional synthetic/biological/targeted synthetic disease-modifying antirheumatic drug initiation, systemic or intra-articular corticosteroid administration and/or RA-related hospitalisation. Pregnancy outcomes were compared computing multivariable logistic marginal regression model using generalised estimating equation (GEE). RESULTS We included 11 792 RA and 10 413 681 non-RA pregnancies. Among RA pregnancies, 74.5% ended in live births and 0.4% in stillbirths. RA pregnancies resulted more frequently in preterm births (adjusted OR (ORa) 1.84; 95% CI 1.69 to 2.00) and very preterm births (ORa 1.43; 95% CI 1.20 to 1.71), low birth weight (ORa 1.65; 95% CI: 1.52 to 1.90), caesarean section (ORa 1.46; 95% CI 1.38 to 1.55) and pregnancy-related hospitalisation (ORa 1.30; 95% CI 1.22 to 1.39). Disease activity decreased during pregnancy. Active RA had higher rates of prematurity (ORa 2.02; 95% CI 1.71 to 2.38), small for gestational age (ORa 1.53; 95% CI 1.28 to 1.83) and caesarean section (ORa 1.25; 95% CI 1.11 to 1.40) than non-active RA. CONCLUSION Pregnancies in women with RA were associated with more adverse outcomes, especially if the disease was active. These findings should encourage physicians to closely monitor RA during this crucial period.
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Affiliation(s)
- Laura Pina Vegas
- Épidémiologie des produits de santé, ANSM-CNAM, EPI-PHARE, Saint-Denis, France
- Service de Rhumatologie, Hopital Henri Mondor, Créteil, France
| | - Jérôme Drouin
- Épidémiologie des produits de santé, ANSM-CNAM, EPI-PHARE, Saint-Denis, France
| | - Alain Weill
- Épidémiologie des produits de santé, ANSM-CNAM, EPI-PHARE, Saint-Denis, France
| | - Rosemary Dray-Spira
- Épidémiologie des produits de santé, ANSM-CNAM, EPI-PHARE, Saint-Denis, France
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Meyer A, Miranda S, Drouin J, Weill A, Carbonnel F, Dray-Spira R. Safety of Vedolizumab and Ustekinumab Compared With Anti-TNF in Pregnant Women With Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00010-7. [PMID: 38199301 DOI: 10.1016/j.cgh.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND & AIMS Limited data are available on the consequences of prenatal exposure to vedolizumab and ustekinumab. We aimed to compare the safety of vedolizumab and ustekinumab with that of anti-tumor necrosis factor (TNF) in pregnant women with inflammatory bowel diseases (IBD). METHODS Using nationwide, comprehensive data of the EPI-MERES registry, we identified pregnancies in women with IBD in France, exposed to anti-TNF, vedolizumab, and ustekinumab between 2014 and 2021. We compared pregnancy outcomes and complications in the offspring according to treatment exposure during pregnancy. We applied a propensity score matching for maternal, IBD, and pregnancy characteristics. RESULTS Three hundred ninety-eight pregnancies exposed to vedolizumab were compared with 1592 pregnancies exposed to anti-TNF; 464 pregnancies exposed to ustekinumab were compared with 1856 pregnancies exposed to anti-TNF. Overall, compared with anti-TNF, neither vedolizumab nor ustekinumab was associated with increased risks of abortion, caesarean section, stillbirth, preterm birth, serious infections, malignancies, or congenital abnormality in children. Women exposed to ustekinumab had an increased risk of small for gestational age births. CONCLUSIONS Overall, the safety of vedolizumab and ustekinumab compared with anti-TNF use during pregnancy is reassuring. Further studies are needed to confirm these findings.
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Affiliation(s)
- Antoine Meyer
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France; Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre & Université Paris-Saclay, Le Kremlin Bicêtre, France.
| | - Sara Miranda
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France
| | - Jérôme Drouin
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France
| | - Alain Weill
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France
| | - Franck Carbonnel
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre & Université Paris-Saclay, Le Kremlin Bicêtre, France
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Veziant J, Boudis F, Lenne X, Bruandet A, Eveno C, Nuytens F, Piessen G. Outcomes Associated With Esophageal Perforation Management: Results From a French Nationwide Population-based Cohort Study. Ann Surg 2023; 278:709-716. [PMID: 37497641 DOI: 10.1097/sla.0000000000006048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To evaluate outcomes associated with esophageal perforation (EP) management at a national level and determine predictive factors of 90-day mortality (90dM), failure-to-rescue (FTR), and major morbidity (MM, Clavien-Dindo 3-4). BACKGROUND EP remains a challenging clinical emergency. Previous population-based studies showed rates of 90dM up to 38.8% but were outdated or small-sized. METHODS Data from patients admitted to hospitals with EP were extracted from the French medico-administrative database (2012-2021). Etiology, management strategies, and short and long-term outcomes were analyzed. A cutoff value of the annual EP management caseload affecting FTR was determined using the "Chi-squared Automatic Interaction Detector" method. Random effects logistic regression model was performed to assess independent predictors of 90dM, FTR, and MM. RESULTS Among 4765 patients with EP, 90dM and FTR rates were 28.0% and 19.4%, respectively. Both remained stable during the study period. EP was spontaneous in 68.2%, due to esophageal cancer in 19.7%, iatrogenic postendoscopy in 7.3%, and due to foreign body ingestion in 4.7%. Primary management consisted of surgery (n = 1447,30.4%), endoscopy (n = 590,12.4%), isolated drainage (n = 336,7.0%), and conservative management (n = 2392,50.2%). After multivariate analysis, besides age and comorbidity, esophageal cancer was predictive of both 90dM and FTR. An annual threshold of ≥8 EP managed annually was associated with a reduced 90dM and FTR rate. In France, only some university hospitals fulfilled this condition. Furthermore, primary surgery was associated with a lower 90dDM and FTR rate despite an increase in MM. CONCLUSIONS We provide evidence for the referral of EP to high-volume centers with multidisciplinary expertise. Surgery remains an effective treatment for EP.
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Affiliation(s)
- Julie Veziant
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, Chu Lille, Lille, France
| | - Fabio Boudis
- Department of Medical Information, Lille University Hospital, Lille, France
| | - Xavier Lenne
- Department of Medical Information, Lille University Hospital, Lille, France
| | - Amelie Bruandet
- Department of Medical Information, Lille University Hospital, Lille, France
| | - Clarisse Eveno
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, Chu Lille, Lille, France
- University of Lille, CNRS, Inserm, Chu Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France
| | - Frederiek Nuytens
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Az Groeninge Hospital, Kortrijk, Belgium
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, Chu Lille, Lille, France
- University of Lille, CNRS, Inserm, Chu Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France
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10
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Meyer A, Rios P, Drouin J, Weill A, Carbonnel F, Dray-Spira R. Maternal Exposure to Anti-TNF or Thiopurines for IBD Does Not Increase Risk of Early-life Malignancy in Children. Clin Gastroenterol Hepatol 2023; 21:2679-2681.e5. [PMID: 36064096 DOI: 10.1016/j.cgh.2022.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Antoine Meyer
- EPIPHARE, Épidémiologie des Produits de Santé, Saint-Denis, France; Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre & Université Paris Saclay, Le Kremlin Bicêtre, France.
| | - Paula Rios
- EPIPHARE, Épidémiologie des Produits de Santé, Saint-Denis, France
| | - Jérôme Drouin
- EPIPHARE, Épidémiologie des Produits de Santé, Saint-Denis, France
| | - Alain Weill
- EPIPHARE, Épidémiologie des Produits de Santé, Saint-Denis, France
| | - Franck Carbonnel
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre & Université Paris Saclay, Le Kremlin Bicêtre, France
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11
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Challine A, Voron T, O'Connell L, Chafai N, Debove C, Collard MK, Parc Y, Lefèvre JH. Does an Ileoanal Anastomosis Decrease the Rate of Successful Pregnancy Compared With an Ileorectal Anastomosis? A National Study of 1491 Patients. Ann Surg 2023; 277:806-812. [PMID: 35837902 DOI: 10.1097/sla.0000000000005569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Report the rate of successful pregnancy in a national cohort of women with either an ileal pouch anal (IPAA) or ileorectal (IRA) anastomosis constructed after colectomy for inflammatory bowel disease (IBD) or polyposis. BACKGROUND Fertility after IPAA is probably impaired. All available data are corroborated by only small sample size studies. It is not known whether construction of IPAA versus IRA influences the odds of subsequently achieving a successful pregnancy, especially with increased utilization of the laparoscopic approach. METHODS All women (age: 12-45 y) undergoing IRA or IPAA in France for polyposis or IBD, between 2010-2020, were included. A control population was defined as women aged from 12 to 45 years undergoing laparoscopic appendicectomy during the same period. The odds of successful pregnancy were studied using an adjusted survival analysis. RESULTS A total of 1491 women (IPAA=872, 58%; IRA=619, 42%) were included. A total of 220 deliveries (15%) occurred during the follow-up period of 71 months (39-100). After adjustment, the odds of successful pregnancy was not significantly associated with type of anastomosis (after IPAA: Hazard Ratio [HR]=0.79, 95% confidence interval=0.56-1.11, P =0.17). The laparoscopic approach increased the odds of achieving successful pregnancy (HR=1.79, 95% confidence interval=1.20-2.63, P =0.004). IRA and IPAA significantly impacted fertility when compared with the control population ( P <0.001). CONCLUSIONS In this large cohort study, total colectomy for polyposis or IBD was associated with reduced fertility compared with the general population. No difference in odds of achieving successful pregnancy was found between IRA and IPAA after adjustment. This analysis suggests laparoscopic surgery may be associated with greater likelihood of pregnancy.
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Affiliation(s)
- Alexandre Challine
- Department of Digestive Surgery, APHP, Hôpital Saint Antoine, Paris, France
- Sorbonne Université, Paris, France
- Centre de Recherche des Cordeliers, Inserm UMR 1138, Sorbonne Université, Université Paris Cité, Paris, France
| | - Thibault Voron
- Department of Digestive Surgery, APHP, Hôpital Saint Antoine, Paris, France
- Sorbonne Université, Paris, France
| | - Lauren O'Connell
- Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Najim Chafai
- Department of Digestive Surgery, APHP, Hôpital Saint Antoine, Paris, France
| | - Clotilde Debove
- Department of Digestive Surgery, APHP, Hôpital Saint Antoine, Paris, France
| | - Maxime K Collard
- Department of Digestive Surgery, APHP, Hôpital Saint Antoine, Paris, France
- Sorbonne Université, Paris, France
| | - Yann Parc
- Department of Digestive Surgery, APHP, Hôpital Saint Antoine, Paris, France
- Sorbonne Université, Paris, France
| | - Jérémie H Lefèvre
- Department of Digestive Surgery, APHP, Hôpital Saint Antoine, Paris, France
- Sorbonne Université, Paris, France
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12
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Cormier J, Merrer J, Blondel B, Le Ray C. Influence of the maternity unit and region of delivery on episiotomy practice in France: a nationwide population-based study. Acta Obstet Gynecol Scand 2023; 102:438-449. [PMID: 36852493 PMCID: PMC10008350 DOI: 10.1111/aogs.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Our objective was to identify factors associated with episiotomy practice in France, in particular, characteristics of the maternity units and regions of delivery. MATERIAL AND METHODS We performed a national cross-sectional population-based study in all French maternity units in 2016 including 9284 women with vaginal delivery. Our outcome was the performance of an episiotomy. After stratification for parity, associations of episiotomy practice with individual and organizational characteristics and the region of delivery were estimated with multilevel logistic regression models. The variability in maternity unit episiotomy rates explained by the characteristics studied was estimated by the proportional change in variance. RESULTS A total of 19.9% of the women had an episiotomy. The principal factors associated with episiotomy practice were maternal and obstetric and delivery in a maternity unit with <2000 annual deliveries. After adjusting for individual, obstetric and organizational characteristics, the practice of episiotomy was strongly associated with women's region of delivery. Additionally, women's individual characteristics did not explain the significant variability in episiotomy rates between maternity units (P < 0.001) but maternity unit characteristics partly did (proportion of variance explained: 7.2% for primiparas and 13.6% for multiparas) and regional differences still more (18% and 30.7%, respectively). CONCLUSIONS Episiotomy practices in France in 2016 varied strongly between maternity units, largely due to regional differences. Targeted actions by the regional perinatal care networks may reduce the national episiotomy rate and standardize practices.
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Affiliation(s)
- Julie Cormier
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Port‐Royal Maternity, AP‐HPHôpital Cochin, FHU PREMAParisFrance
| | - Jade Merrer
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Clinical Epidemiology Unit, Robert Debré HospitalAssistance Publique‐Hôpitaux de ParisParisFrance
| | - Béatrice Blondel
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
| | - Camille Le Ray
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Port‐Royal Maternity, AP‐HPHôpital Cochin, FHU PREMAParisFrance
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13
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Lailler G, Grave C, Gabet A, Regnault N, Deneux-Tharaux C, Kretz S, Tsatsaris V, Plu-Bureau G, Blacher J, Olie V. Aspirin for the Prevention of Early and Severe Pre-Eclampsia Recurrence: A Real-World Population-Based Study. Drugs 2023; 83:429-437. [PMID: 36867398 PMCID: PMC10042896 DOI: 10.1007/s40265-023-01842-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Many clinical trials have reported that low-dose aspirin decreases the risk of pre-eclampsia in women with prior pre-eclampsia. However, its impact in a real-world population has not been fully assessed. OBJECTIVES To assess the rates of low-dose aspirin initiation during pregnancy in women with a history of pre-eclampsia, and to evaluate the impact of low-dose aspirin in prevention of pre-eclampsia recurrence in a real-world population. STUDY DESIGN CONCEPTION is a French nationwide cohort study which uses data from the country's National Health Data System database. We included all women in France who gave birth at least twice between 2010-2018, and who had pre-eclampsia during their first pregnancy. Every dispensing of low-dose aspirin (75-300 mg) between the beginning of their second pregnancy and 36 weeks of gestation (WG) was identified. We used Poisson regression models to estimate the adjusted incidence rate ratios (aIRRs) of receiving aspirin at least once during their second pregnancy. In women who had early and/or severe pre-eclampsia during their first pregnancy, we estimated the IRRs of pre-eclampsia recurrence during their second pregnancy according to the aspirin therapy. RESULTS In 28,467 women who were included in the study, the aspirin initiation rate during the second pregnancy ranged from 27.8% for women in whose first pregnancy the pre-eclampsia was mild and late, to 79.9% for those women whose pre-eclampsia was severe and early. Just over half (54.3%) of those treated with aspirin-initiated treatment before 16 WG and adhered to treatment. Compared with women with mild and late pre-eclampsia, the aIRRs (95% CI) for receiving aspirin at least once during the second pregnancy were 1.94 (1.86-2.03) for women with severe and late pre-eclampsia, 2.34 (2.17-2.52) for those with early and mild pre-eclampsia, and 2.87 [2.74-3.01] for those with early and severe pre-eclampsia E. Social deprivation was associated with a lower initiation of aspirin (IRR = 0.74 [0.70-0.78]). Aspirin was not associated with a lower risk of mild and late pre-eclampsia, severe and late pre-eclampsia, or mild and early pre-eclampsia during the second pregnancy. The aIRRs for severe and early pre-eclampsia during the second pregnancy were 0.77 (0.62-0.95) for women who received prescribed aspirin at least once, 0.71 (0.5-0.89) for those who initiated aspirin therapy before 16 WG, and 0.60 (0.47-0.77) for those who adhered to aspirin treatment throughout their second pregnancy. The risk of severe and early pre-eclampsia was lower only when the prescribed mean daily dose was ≥ 100 mg/day. CONCLUSION In women with a history of pre-eclampsia, aspirin initiation during a second pregnancy and adherence to the prescribed dosage were largely insufficient, especially for women experiencing social deprivation. Aspirin initiated before 16 WG at a dose ≥ 100 mg/day was associated with a lower risk of severe and early pre-eclampsia.
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Affiliation(s)
- Grégory Lailler
- Santé publique France, Saint-Maurice, France.
- Université Paris Est, Créteil, France.
| | | | | | | | - Catherine Deneux-Tharaux
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France
- Université Paris Cité, Paris, France
| | - Sandrine Kretz
- Centre de diagnostic et de thérapeutique, Hôtel Dieu, AP-HP, Paris, France
| | - Vassilis Tsatsaris
- Université Paris Cité, Paris, France
- Maternité Port-Royal, FHU PREMA, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Geneviève Plu-Bureau
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France
- Université Paris Cité, Paris, France
- Unité de gynécologie médicale, APHP, Hôpital Port-Royal Cochin, Paris, France
| | - Jacques Blacher
- Université Paris Cité, Paris, France
- Centre de diagnostic et de thérapeutique, Hôtel Dieu, AP-HP, Paris, France
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14
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Goueslard K, Jollant F, Cottenet J, Bechraoui-Quantin S, Rozenberg P, Simon E, Quantin C. Hospitalisation for non-lethal self-harm and premature mortality in the 3 years following adolescent pregnancy: Population-based nationwide cohort study. BJOG 2023. [PMID: 36808811 DOI: 10.1111/1471-0528.17432] [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: 05/11/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To evaluate the risk of non-lethal self-harm and mortality related to adolescent pregnancy. DESIGN Nationwide population-based retrospective cohort. SETTING Data were extracted from the French national health data system. POPULATION We included all adolescents aged 12-18 years with an International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) code for pregnancy in 2013-2014. METHODS Pregnant adolescents were compared with age-matched non-pregnant adolescents and with first-time pregnant women aged 19-25 years. MAIN OUTCOME MEASURES Any hospitalisation for non-lethal self-harm and mortality during a 3-year follow-up period. Adjustment variables were age, a history of hospitalisation for physical diseases, psychiatric disorders, self-harm and reimbursed psychotropic drugs. Cox proportional hazards regression models were used. RESULTS In 2013-2014, 35 449 adolescent pregnancies were recorded in France. After adjustment, pregnant adolescents had an increased risk of subsequent hospitalisation for non-lethal self-harm in comparison with both non-pregnant adolescents (n = 70 898) (1.3% vs 0.2%, HR 3.06, 95% CI 2.57-3.66) and pregnant young women (n = 233 406) (0.5%, HR 2.41, 95% CI 2.14-2.71). Rates of hospitalisation for non-lethal self-harm were lower during pregnancy and higher between 12 and 8 months pre-delivery, 3-7 months postpartum and in the month following abortion. Mortality was significantly higher in pregnant adolescents (0.7‰) versus pregnant young women (0.4‰, HR 1.74, 95% CI 1.12-2.72), but not versus non-pregnant adolescents (0.4‰, HR 1.61, 95% CI 0.92-2.83). CONCLUSIONS Adolescent pregnancy is associated with an increased risk of hospitalisation for non-lethal self-harm and premature death. Careful psychological evaluation and support should be systematically implemented for adolescents who are pregnant.
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Affiliation(s)
- Karine Goueslard
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Fabrice Jollant
- Department of Psychiatry, Paris-Saclay University and Academic Hospital (CHU) Bicêtre, Le Kremlin-Bicêtre, France.,Department of Psychiatry, Nîmes Academic Hospital (CHU), Nîmes, France.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,MOODS Research Team, Centre de recherche en Epidémiologie et santé des populations (CESP), Institut national de la santé et de la recherche médicale (Inserm), Le Kremlin-Bicêtre, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Sonia Bechraoui-Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.,Gynecology, Obstetrics and Fetal Medicine, University Hospital, Dijon, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Hôpital Intercommunal de Poissy, Université Versailles Saint-Quentin, Poissy, France
| | - Emmanuel Simon
- Gynecology, Obstetrics and Fetal Medicine, University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.,Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Université Paris-Saclay, Université Versailles Saint-Quentin, Université Paris-Sud, Villejuif, France
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15
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Lailler G, Grave C, Gabet A, Regnault N, Deneux-Tharaux C, Kretz S, Tsatsaris V, Plu-Bureau G, Blacher J, Olié V. Recurrence of hypertensive disorders of pregnancy: results from a nationwide prospective cohort study (CONCEPTION). BJOG 2023. [PMID: 36802131 DOI: 10.1111/1471-0528.17424] [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: 07/22/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To assess the risk of gestational hypertension (GH) and pre-eclampsia (PE) during a second pregnancy after occurrence during a first pregnancy. DESIGN Prospective cohort study. SETTING CONCEPTION is a French nationwide cohort study that used data from the National Health Data System (SNDS) database. METHODS We included all women who gave birth for the first time in France in 2010-2018 and who subsequently gave birth. We identified GH and PE through hospital diagnoses and the dispensing of anti-hypertensive drugs. The incidence rate ratios (IRR) of all hypertensive disorder of pregnancy (HDP) during the second pregnancy were estimated using Poisson models adjusted for confounding. MAIN OUTCOME MEASURES Incidence rate ratios of HDP during the second pregnancy. RESULTS Of the 2 829 274 women included, 238 506 (8.4%) were diagnosed with HDP during their first pregnancy. In women with GH during their first pregnancy, 11.3% (IRR 4.5, 95% confidence interval [CI] 4.4-4.7) and 3.4% (IRR 5.0, 95% CI 4.8-5.3) developed GH and PE during their second pregnancy, respectively. In women with PE during their first pregnancy, 7.4% (IRR 2.6, 95% CI 2.5-2.7) and 14.7% (IRR 14.3, 95% CI 13.6-15.0) developed GH and PE during their second pregnancy, respectively. The more severe and earlier the PE during the first pregnancy, the stronger the likelihood of having PE during the second pregnancy. Maternal age, social deprivation, obesity, diabetes and chronic hypertension were all associated with PE recurrence. CONCLUSION These results can guide policymaking that focuses on improving counselling for women who wish to become pregnant more than once, by identifying those who would benefit more from tailored management of modifiable risk factors, and heightened surveillance during post-first pregnancies.
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Affiliation(s)
- G Lailler
- Santé Publique France, Saint-Maurice, France.,Université Paris Est, Créteil, France
| | - C Grave
- Santé Publique France, Saint-Maurice, France
| | - A Gabet
- Santé Publique France, Saint-Maurice, France
| | - N Regnault
- Santé Publique France, Saint-Maurice, France
| | - C Deneux-Tharaux
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France.,Université Paris Cité, Paris, France
| | - S Kretz
- Centre de Diagnostic et de Thérapeutique, Paris, France
| | - V Tsatsaris
- Université Paris Cité, Paris, France.,Maternité Port-Royal, FHU PREMA, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - G Plu-Bureau
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France.,Université Paris Cité, Paris, France.,Unité de Gynécologie Médicale, APHP, Hôpital Port-Royal Cochin, Paris, France
| | - J Blacher
- Université Paris Cité, Paris, France.,Centre de Diagnostic et de Thérapeutique, Paris, France
| | - V Olié
- Santé Publique France, Saint-Maurice, France
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16
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Ray CL, Lelong N, Cinelli H, Blondel B, Lelong N, Cinelli H, Blondel B, Regnault N, Demiguel V, Lebreton E, Salanave B, Fresson J, Vilain A, Deroyon T, Raynaud P, Rey S, Chemlal K, Rabier-Thoreau N. Results of the 2021 French National Perinatal Survey and trends in perinatal health in metropolitan France since 1995. J Gynecol Obstet Hum Reprod 2022; 51:102509. [PMID: 36410664 DOI: 10.1016/j.jogoh.2022.102509] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report results of the 2021 French National Perinatal Survey (ENP) in metropolitan France and assess trends in the main indicators of perinatal health, medical practices, and risk factors in France since 1995. POPULATION AND METHOD All the samples included all women giving birth at a gestational age of at least 22 weeks of gestation and/or to an infant weighing at least 500 grams in all maternity units in metropolitan France during one week in 1995 (N=13 048), 2003 (N=14 324), 2010 (N=14 546), 2016 (N=12 553), and 2021 (N=12 088). The data came from postpartum interviews of the women at the hospital and their medical records. Comparisons between surveys showed trends over time. RESULTS Between 1995 and 2021, maternal characteristics changed. Maternal age and the frequency of women with obesity rose: in 2021, 24.6% of women were 35 years or older (21.1% in 2016, 19.2% in 2010, 15.9% in 2003 and 12.4% in 1995) and 14.4% were obese (11.8% in 2016, 9.9% in 2010 and 7.4% in 2003). Some antenatal prevention behaviors that improved in 2021 were not smoking during the third trimester, acid folic administration before pregnancy, and vaccination against influenza. The percentage of women with an early prenatal appointment ("4th month appointment"), implemented to facilitate screening of maternal vulnerability during pregnancy, has continued to rise. The percentage of women receiving prenatal care by midwives has risen markedly (39.0% in 2021 versus 11.7% in 2016). Serum screening for Down syndrome continues to increase (91.8% of women in 2021). The rate of induction of labor has risen significantly (20.2% in 1995 and 25.8% in 2021). The mode of delivery has not varied significantly since 2003; in 2021, the cesarean rate was 21.4% and the instrumental vaginal delivery rate 12.4%. Episiotomy was increasingly rare, among both primiparous and multiparous women (16.5% and 2.9% in 2021, respectively). The prevalence of coronavirus (SARS-CoV2) infection during pregnancy was 5.7%. Preterm live births increased regularly, slightly but significantly over the 1995-2016 period and then remained stable between 2016 and 2021 (7.0%). In 2021, 56.3% of women exclusively breastfed during their hospital stay, a modest increase in comparison with 2016 (54.6%). CONCLUSION Routine national perinatal surveys highlight positive trends over time in some preventive practices, decreases in some medical interventions consistent with national guidelines, and the increasing role of midwives in prenatal care. Nonetheless, some indicators remain less than optimal and require more detailed analyses.
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Affiliation(s)
- Camille Le Ray
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), CRESS, INSERM, INRAE, Université Paris Cité, 75014 Paris, France; Maternité Port-Royal, Groupe hospitalier Paris Centre, AP-HP, Université Paris Cité, FHU Prema, 75014 Paris.
| | - Nathalie Lelong
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), CRESS, INSERM, INRAE, Université Paris Cité, 75014 Paris, France
| | - Hélène Cinelli
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), CRESS, INSERM, INRAE, Université Paris Cité, 75014 Paris, France
| | - Béatrice Blondel
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), CRESS, INSERM, INRAE, Université Paris Cité, 75014 Paris, France
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17
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Meyer A, Neumann A, Drouin J, Weill A, Carbonnel F, Dray-Spira R. Benefits and Risks Associated With Continuation of Anti-Tumor Necrosis Factor After 24 Weeks of Pregnancy in Women With Inflammatory Bowel Disease : A Nationwide Emulation Trial. Ann Intern Med 2022; 175:1374-1382. [PMID: 36162111 DOI: 10.7326/m22-0819] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Continuation of biologics for inflammatory disorders during pregnancy is still a difficult decision. Many women with inflammatory bowel diseases (IBDs) stop anti-tumor necrosis factor (anti-TNF) treatment after 24 weeks. OBJECTIVE To evaluate the benefits and risks of anti-TNF continuation after 24 weeks of pregnancy for mothers with IBD and their offspring. DESIGN Target trial emulation between 2010 and 2020. SETTING Nationwide population-based study using the Système National des Données de Santé. PATIENTS All pregnancies with birth exposed to anti-TNF between conception and 24 weeks of pregnancy in women with IBD. INTERVENTION Continuation of anti-TNF after 24 weeks of pregnancy. MEASUREMENTS Occurrence of maternal IBD relapse up to 6 months after pregnancy, adverse pregnancy outcomes, and serious infections in the offspring during the first 5 years of life was compared according to anti-TNF continuation after 24 weeks of pregnancy using inverse probability-weighted marginal models. RESULTS A total of 5293 pregnancies were included; among them, anti-TNF treatment was discontinued before 24 weeks for 2890 and continued beyond 24 weeks for 2403. Continuation of anti-TNF was associated with decreased frequencies of maternal IBD relapse (35.8% vs. 39.0%; adjusted risk ratio [aRR], 0.93 [95% CI, 0.86 to 0.99]) and prematurity (7.6% vs. 8.9%; aRR, 0.82 [CI, 0.68 to 0.99]). No difference according to anti-TNF continuation was found regarding stillbirths (0.4% vs. 0.2%; aRR, 2.16 [CI, 0.64 to 7.81]), small weight for gestational age births (13.1% vs. 12.9%; aRR, 1.01 [CI, 0.88 to 1.17]), and serious infections in the offspring (54.2 vs. 50.2 per 1000 person-years; adjusted hazard ratio, 1.08 [CI, 0.94 to 1.25]). LIMITATION Algorithms rather than clinical data were used to identify patients with IBD, pregnancies, and serious infections. CONCLUSION Continuation of anti-TNF after 24 weeks of pregnancy appears beneficial regarding IBD activity and prematurity, while not affecting neonatal outcomes and serious infections in the offspring. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Antoine Meyer
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, and Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre & Université Paris-Saclay, Le Kremlin Bicêtre, France (A.M.)
| | - Anke Neumann
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France (A.N., J.D., A.W., R.D.)
| | - Jérôme Drouin
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France (A.N., J.D., A.W., R.D.)
| | - Alain Weill
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France (A.N., J.D., A.W., R.D.)
| | - Franck Carbonnel
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre & Université Paris-Saclay, Le Kremlin Bicêtre, France (F.C.)
| | - Rosemary Dray-Spira
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France (A.N., J.D., A.W., R.D.)
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18
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Meyer A, Taine M, Drouin J, Weill A, Carbonnel F, Dray-Spira R. Serious Infections in Children Born to Mothers With Inflammatory Bowel Disease With In Utero Exposure to Thiopurines and Anti-Tumor Necrosis Factor. Clin Gastroenterol Hepatol 2022; 20:1269-1281.e9. [PMID: 34298191 DOI: 10.1016/j.cgh.2021.07.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We aimed to compare the risk of serious infections in children with in utero exposure to thiopurines and/or anti-tumor necrosis factor (TNF) born to mothers with inflammatory bowel disease (IBD). METHODS Using the French national health database, which covers 99% of the French population (around 66,000,000 people), we identified live births among women with IBD in France between 2010 and 2018. The risks of serious infections in children during the first 5 years of life were compared according to treatment exposures during pregnancy using propensity score-weighted marginal Cox models. RESULTS A total of 26,561 children were included: 3392 were exposed to thiopurine monotherapy, 3399 to anti-TNF monotherapy, 816 to combination therapy, and 18,954 were not exposed to any of these drugs. The risks of serious infections during the first year of life among children exposed to thiopurine monotherapy (adjusted hazard ratio [aHR], 0.94; 95% confidence interval [CI], 0.83-1.07) and anti-TNF monotherapy (aHR, 1.10; 95% CI, 0.95-1.27) were similar to those of unexposed children; a higher risk was observed in children exposed to combination therapy (aHR, 1.36; 95% CI, 1.04-1.79). The highest increased risks were observed for nervous system infections and viral infections. The risk of serious infections during the second to fifth years of life was not associated with IBD treatments. CONCLUSIONS In children born to mothers with IBD, in utero exposure to thiopurine and anti-TNF monotherapies do not increase the risk of serious infections during the first 5 years of life. Combination therapy is associated with an increased risk of serious infections during the first year of life.
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Affiliation(s)
- Antoine Meyer
- EPIPHARE, Épidémiologie des Produits de Santé, ANSM-CNAM, Saint Denis, France; Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France & Université Paris Sud, Le Kremlin Bicêtre, France.
| | - Marion Taine
- EPIPHARE, Épidémiologie des Produits de Santé, ANSM-CNAM, Saint Denis, France
| | - Jérôme Drouin
- EPIPHARE, Épidémiologie des Produits de Santé, ANSM-CNAM, Saint Denis, France
| | - Alain Weill
- EPIPHARE, Épidémiologie des Produits de Santé, ANSM-CNAM, Saint Denis, France
| | - Franck Carbonnel
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France & Université Paris Sud, Le Kremlin Bicêtre, France
| | - Rosemary Dray-Spira
- EPIPHARE, Épidémiologie des Produits de Santé, ANSM-CNAM, Saint Denis, France
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19
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Fresson J, Bruckner TA, Ray CL, Goffinet F, Rey S, Blondel B, Deneux-Tharaux C, Ancel PY, Zeitlin J. Decreases in preterm birth during the first COVID-19 lockdown in France by gestational age sub-groups and regional COVID-19 incidence. Ann Epidemiol 2022; 72:74-81. [DOI: 10.1016/j.annepidem.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 05/08/2022] [Accepted: 05/17/2022] [Indexed: 11/01/2022]
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20
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Lebreton E, Menguy C, Fresson J, Egorova NN, Crenn Hebert C, Zeitlin J. Measuring severe neonatal morbidity using hospital discharge data in France. Paediatr Perinat Epidemiol 2022; 36:190-201. [PMID: 34797588 DOI: 10.1111/ppe.12816] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/11/2021] [Accepted: 08/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Measuring infant health at birth is key for surveillance and research in obstetrics and neonatology, but there is no international consensus on morbidity indicators. The Neonatal Adverse Outcome Indicator (NAOI) is a composite indicator, developed in Australia, which measures the burden of severe neonatal morbidity using hospital discharge data. OBJECTIVE To evaluate the applicability of the NAOI in France for surveillance and research. METHODS We constituted a cohort of live births ≥24 weeks' gestational age in Metropolitan France from 2014 to 2015 using hospital discharge, insurance claims and cause of death data. Outlier hospitals were identified using funnel plots of standardised morbidity ratios (SMR), and their coding patterns were assessed. We compared the NAOI and its component codes with published Australian and English data and estimated unadjusted and adjusted risk ratios for known risk factors for neonatal morbidity. RESULTS We included 1,459,123 births (511 hospitals). Twenty-eight hospitals had SMR above funnel plot control limits. Newborns with NAOI morbidities in these hospitals had lower mortality and shorter stays than in other hospitals. Amongst within-limit hospitals, NAOI prevalence was 4.8%, comparable to Australia (4.6%) and England (5.4%). Most individual components had a similar prevalence, with the exception of respiratory support, intravenous fluid procedures and infection. NAOI was lowest at 39 weeks (2.2%) with higher risks for maternal age ≥40 (relative risk [RR] 1.47, 95% confidence interval [CI] 1.42, 1.51), state medical insurance (RR 1.60, 95% CI 1.52, 1.68), male sex (RR 1.21, 95% CI 1.19, 1.23) and birthweight <3rd percentile (RR 4.60, 95% CI 4.51, 4.69). CONCLUSIONS The NAOI provides valuable information on population prevalence of severe neonatal morbidity and its risk factors. Whilst the prevalence was similar in high-income countries with comparable neonatal mortality levels, ensuring valid comparisons between countries and hospitals will require further work to harmonize coding procedures, especially for infection and respiratory morbidity.
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Affiliation(s)
- Elodie Lebreton
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Non Communicable Diseases and Trauma Division, Santé publique France, The National Public Health Agency, Saint-Maurice, France.,Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Saint-Denis, France
| | - Claudie Menguy
- Non Communicable Diseases and Trauma Division, Santé publique France, The National Public Health Agency, Saint-Maurice, France.,Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Saint-Denis, France
| | - Jeanne Fresson
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Medical Information, Maternity of University Hospital - CHRU Nancy, Nancy, France
| | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Catherine Crenn Hebert
- Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Saint-Denis, France.,Maternity Unit, University Hospital (APHP), Hôpital Louis Mourier, Colombes, France
| | - Jennifer Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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21
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Challine A, Maggiori L, Katsahian S, Corté H, Goere D, Lazzati A, Cattan P, Chirica M. Outcomes Associated With Caustic Ingestion Among Adults in a National Prospective Database in France. JAMA Surg 2021; 157:112-119. [PMID: 34878529 DOI: 10.1001/jamasurg.2021.6368] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Caustic ingestion in adults may result in death or severe digestive sequelae. The scarcity of nationwide epidemiological data leads to difficulties regarding the applicability of their analysis to less specialized centers, which are nevertheless largely involved in the emergency management of adverse outcomes following caustic ingestion. Objective To assess outcomes associated with caustic ingestion in adults across a nationwide prospective database. Design, Settings, and Participants Adult patients aged 16 to 96 admitted to the emergency department for caustic ingestion between January 2010 and December 2019 were identified from the French Medical Information System Database, which includes all patients admitted in an emergency setting in hospitals in France during this period. Exposure Esophageal caustic ingestion. Main Outcomes and Measures The primary end point was in-hospital patient outcomes following caustic ingestion. Multivariate analysis was performed to assess independent predictors of in-hospital morbidity and mortality. Results Among 22 657 226 patients admitted on an emergency outpatient basis, 3544 (0.016%) had ingested caustic agents and were included in this study. The median (IQR) age in this population was 49 (34-63) years, and 1685 patients (48%) were women. Digestive necrosis requiring resection was present during the primary hospital stay in 388 patients with caustic ingestion (11%). Nonsurgical management was undertaken in 3156 (89%). A total of 1198 (34%) experienced complications, and 294 (8%) died. Pulmonary complications were the most frequent adverse event, occurring in 869 patients (24%). On multivariate analysis, predictors of mortality included old age, high comorbidity score, suicidal ingestion, intensive care unit admission during management, emergency surgery for digestive necrosis, and treatment in low-volume centers. On multivariate analysis, predictors of morbidity included old age, higher comorbidity score, intensive care unit admission during management, and emergency surgery for digestive necrosis. Conclusions and Relevance In this study, referral to expert centers was associated with improved early survival after caustic ingestion. If feasible, low-volume hospitals should consider transferring patients to larger centers instead of attempting on-site management.
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Affiliation(s)
- Alexandre Challine
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France.,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1138 Team 22, Centre de Recherche des Cordeliers, Paris, France
| | - Léon Maggiori
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Sandrine Katsahian
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1138 Team 22, Centre de Recherche des Cordeliers, Paris, France.,Université de Paris, Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité d'Épidémiologie et de Recherche Clinique, Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique 1418, Module Épidémiologie Clinique, Paris, France
| | - Hélène Corté
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Diane Goere
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Andrea Lazzati
- Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000 Créteil, France.,Institut National de la Santé et de la Recherche Médicale, L'Institut Mondor de Recherche Biomédicale, U955, Université Paris-Est Créteil, France
| | - Pierre Cattan
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
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22
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Lequeu JB, Cottenet J, Facy O, Perrin T, Bernard A, Quantin C. Failure to rescue in patients with distal pancreatectomy: a nationwide analysis of 10,632 patients. HPB (Oxford) 2021; 23:1410-1417. [PMID: 33622649 DOI: 10.1016/j.hpb.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND FTR appears as a major cause of postoperative mortality (POM). Hospital volume has an impact on FTR in pancreatic surgery but no study has investigated this relationship more specifically in DP. METHODS We analysed patients with DP between 2009 and 2018 through a nationwide database. FTR definition was mortality among patients who experiment major complications. The cutoff between high and low volume centers was 20 pancreatectomies per year. RESULTS Some 10,632 patients underwent DP, 5048 (47.5%) were operated in 602 (95.4%) low volume centers and 5584 (52.5%) in 29 (4.6%) high volume centers. Overall FTR occurred in 11.2% of patients and was significantly reduced in high volume centers compared to low volume centers (10.2% vs 12.5%, p = 0.047). In multivariate analysis, surgery in a high volume center was a protective factor for POM (OR = 0.570, CI95% [0.505-0.643], p < 0.001) and also for FTR (OR = 0.550, CI95% [0.486-0.630], p < 0.001). CONCLUSION Hospital volume has a positive impact on FTR in DP. Patients with higher risk of FTR are men, with high modified Charlson comorbidity index, malignant conditions and open procedures.
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Affiliation(s)
- Jean-Baptiste Lequeu
- Dijon University Hospital, Department of Digestive Surgical Oncology, Dijon F-21000, France.
| | - Jonathan Cottenet
- Dijon University Hospital, Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, Dijon F-21000, France
| | - Olivier Facy
- Dijon University Hospital, Department of Digestive Surgical Oncology, Dijon F-21000, France
| | - Thomas Perrin
- Dijon University Hospital, Department of Digestive Surgical Oncology, Dijon F-21000, France
| | - Alain Bernard
- Dijon University Hospital, Department of Thoracic Surgery, Dijon F-21000, France
| | - Catherine Quantin
- Dijon University Hospital, Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, Dijon F-21000, France
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23
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Quantin C, Yamdjieu Ngadeu C, Cottenet J, Escolano S, Bechraoui‐Quantin S, Rozenberg P, Tubert‐Bitter P, Gouyon J. Early exposure of pregnant women to non-steroidal anti-inflammatory drugs delivered outside hospitals and preterm birth risk: nationwide cohort study. BJOG 2021; 128:1575-1584. [PMID: 33590634 PMCID: PMC8451913 DOI: 10.1111/1471-0528.16670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the risk of preterm birth associated with nonsteroidal anti-inflammatory drugs (NSAIDs), focusing on early exposure in the period from conception to 22 weeks of gestation (WG). DESIGN National population-based retrospective cohort study. SETTING The French National Health Insurance Database that includes hospital discharge data and health claims data. POPULATION Singleton pregnancies (2012-2014) with a live birth occurring after 22WG from women between 15 and 45 years old and insured the year before the first day of gestation and during pregnancy were included. We excluded pregnancies for which anti-inflammatory medications were dispensed after 22WG. METHODS The association between exposure and risk of preterm birth was evaluated with GEE models, adjusting on a large number of covariables, socio-demographic variables, maternal comorbidities, prescription drugs and pregnancy complications. MAIN OUTCOME MEASURES Prematurity, defined as a birth that occurred before 37WG. RESULTS Among our 1 598 330 singleton pregnancies, early exposure to non-selective NSAIDs was associated with a significantly increased risk of preterm birth, regardless of the severity of prematurity: adjusted odds ratio (aOR) = 1.76 (95% CI 1.54-2.00) for extreme prematurity (95% CI 22-27WG), 1.28 (95% CI 1.17-1.40) for moderate prematurity (28-31WG) and 1.08 (95% CI 1.05-1.11) for late prematurity (32-36WG), with non-overlapping confidence intervals. We identified five NSAIDs for which the risk of premature birth was significantly increased: ketoprofen, flurbiprofen, nabumetone, etodolac and indomethacin: for the latter, aOR = 1.92 (95% CI 1.37-2.70) with aOR = 9.33 (95% CI 3.75-23.22) for extreme prematurity. CONCLUSION Overall, non-selective NSAID use (delivered outside hospitals) during the first 22WG was found to be associated with an increased risk of prematurity. However, the association differs among NSAIDs. TWEETABLE ABSTRACT French study for which early exposure to non-selective NSAIDs was associated with increased risk of prematurity.
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Affiliation(s)
- C Quantin
- High‐Dimensional Biostatistics for Drug Safety and GenomicsUniversité Paris‐SaclayUVSQUniv. Paris‐SudInsermCESPVillejuifFrance
- Biostatistics and Bioinformatics (DIM)University HospitalDijonFrance
- Bourgogne Franche‐Comté UniversityDijonFrance
- InsermCIC 1432DijonFrance
- Clinical Investigation CentreClinical Epidemiology/Clinical Trials UnitDijon University HospitalDijonFrance
| | - C Yamdjieu Ngadeu
- Biostatistics and Bioinformatics (DIM)University HospitalDijonFrance
- Bourgogne Franche‐Comté UniversityDijonFrance
| | - J Cottenet
- Biostatistics and Bioinformatics (DIM)University HospitalDijonFrance
- Bourgogne Franche‐Comté UniversityDijonFrance
| | - S Escolano
- High‐Dimensional Biostatistics for Drug Safety and GenomicsUniversité Paris‐SaclayUVSQUniv. Paris‐SudInsermCESPVillejuifFrance
| | - S Bechraoui‐Quantin
- Biostatistics and Bioinformatics (DIM)University HospitalDijonFrance
- Bourgogne Franche‐Comté UniversityDijonFrance
| | - P Rozenberg
- Department of Obstetrics and GynaecologyPoissy‐Saint Germain HospitalPoissyFrance
- Paris Saclay University, UVSQ, Inserm, Team U1018, Clinical Epidemiology, CESPMontigny‐le‐BretonneuxFrance
| | - P Tubert‐Bitter
- High‐Dimensional Biostatistics for Drug Safety and GenomicsUniversité Paris‐SaclayUVSQUniv. Paris‐SudInsermCESPVillejuifFrance
| | - J‐B Gouyon
- Centre d’Etudes Périnatales Océan Indien (EA 7388)Centre Hospitalier Universitaire Sud RéunionLa RéunionSaint PierreFrance
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24
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Meyer A, Drouin J, Weill A, Carbonnel F, Dray-Spira R. Comparative study of pregnancy outcomes in women with inflammatory bowel disease treated with thiopurines and/or anti-TNF: a French nationwide study 2010-2018. Aliment Pharmacol Ther 2021; 54:302-311. [PMID: 34162011 DOI: 10.1111/apt.16448] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/16/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data about thiopurines or anti-TNF use during pregnancy in women with inflammatory bowel diseases (IBD) are reassuring. However, many studies are based upon small sample sizes. AIMS To assess IBD medication safety during pregnancy. METHODS Using the French national health database, which covers more than 99% of the French population, around 65 000 000 people, we identified pregnancies ending with a birth in IBD patients in France between 2010 and 2018. Pregnancy outcomes (vital status at birth, birth term, and weight for gestational age) were compared according to treatment exposure during pregnancy using propensity score-weighted marginal logistic regression models. RESULTS 27 729 pregnancies were included: 3554 were exposed to thiopurines monotherapy, 3525 to anti-TNF monotherapy, 839 to combination therapy, and 19 811 unexposed. Pregnancies exposed to thiopurines monotherapy compared to unexposed pregnancies more frequently resulted in stillbirths (1.0% vs 0.5%, aOR 2.04; 95%CI: 1.18-3.55), preterm birth (12.3% vs 7.1%, aOR 1.76; 95%CI: 1.55-2.00), large for gestational age (10.6% vs 8.4%, aOR 1.32; 95%CI: 1.13-1.53) and less frequently in small for gestational age (9.6% vs 11.1%, aOR 0.79; 95%CI: 0.67-0.92). By contrast, pregnancies exposed to anti-TNF monotherapy were not different from unexposed pregnancies as regards to these outcomes. Compared to unexposed pregnancies, those exposed to combination therapy more frequently resulted in preterm births (aOR 1.55; 95%CI: 1.15-2.11) and larger for gestational age (aOR 1.61; 95%CI: 1.13-2.29) but did not differ as regards to stillbirths. CONCLUSIONS Pregnancies exposed to thiopurines more frequently resulted in stillbirths, preterm births and large for gestational age compared to pregnancies exposed to anti-TNF or unexposed pregnancies. By contrast, pregnancies exposed to anti-TNF monotherapy were not associated with these outcomes.
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Affiliation(s)
- Antoine Meyer
- EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, Denis, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Jérôme Drouin
- EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, Denis, France
| | - Alain Weill
- EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, Denis, France
| | - Franck Carbonnel
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Université Paris-Saclay, Le Kremlin Bicêtre, France
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25
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Demiguel V, Laporal S, Quatremere G, Barry Y, Guseva Canu I, Goulet V, Germanaud D, Regnault N. The frequency of severe Fetal Alcohol Spectrum Disorders in the neonatal period using data from the French hospital discharge database between 2006 and 2013. Drug Alcohol Depend 2021; 225:108748. [PMID: 34058539 DOI: 10.1016/j.drugalcdep.2021.108748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUNDS At birth, only complete Fetal Alcohol Syndrome (FAS) can be properly diagnosed. However, other Consequences of prenatal Alcohol Exposure (CAE) can also be recorded. Our objective was to describe the frequency of diagnoses highly suggestive of "potential Fetal Alcohol Syndrome Disorder" (pFASD, i.e., FAS and CAE) among hospitalized neonates, during the neonatal period, in France, between 2006 and 2013. METHODS We used the French national hospital discharge database to identify the Q86.0 (FAS) and P04.3 (CAE) ICD-10 codes in hospital stays occurring in the first 28 days of life. FAS, CAE and pFASD rates were estimated per 1000 live births at the national level for the 2009-2013 period. We compared the 2006-2009 and 2010-2013 rates. The pFASD rates were also estimated at the regional level. RESULTS Overall, 3,207 cases of pFASD were diagnosed during the neonatal period (i.e., 0.48 cases per 1000 live births, including 0.07 cases of FAS per 1000). Between 2006-2009 and 2010-2013, pFASD remained stable, despite a moderate decrease in reported FAS (0.08 vs 0.06 cases per 1000, p < 0.001). At the regional level, pFASD rates varied between 0.13 and 1.22 cases per 1000. CONCLUSIONS This study provides the first national estimate of neonatal diagnosis of FAS, and more broadly pFASD, in France. Although our data certainly underestimate the real prevalence of FASD, they provide a minimal estimate of the burden of alcohol use during pregnancy. Observed variations deserve to be analyzed in the light of concomitant prevention and public information campaigns.
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Affiliation(s)
- Virginie Demiguel
- Santé publique France, French National Public Health Agency, F-94415 Saint-Maurice, France.
| | - Stella Laporal
- Santé publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Guillemette Quatremere
- Santé publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Yaya Barry
- Santé publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Irina Guseva Canu
- Santé publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Véronique Goulet
- Santé publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - David Germanaud
- Assistance Publique - Hôpitaux de Paris, Hôpital Robert-Debré, Centre d'Excellence InovAND, Service de Neurologie et des Maladies Métaboliques, Paris, France; Université de Paris, Inserm, CEA, UMR1141 NeuroDiderot, équipe InDev, Paris, France; CEA, Institut Juliot, NeuroSpin, UNIACT, Gif-sur-Yvette, France
| | - Nolwenn Regnault
- Santé publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
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26
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Chantry AA, Monnet C, Fresson J, Miller D, Bonnet MP, Deneux-Tharaux C. Repeated maternal ICU admission: results from a nationwide analysis. Anaesth Crit Care Pain Med 2021; 40:100905. [PMID: 34153532 DOI: 10.1016/j.accpm.2021.100905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the rate and profile of repeated maternal ICU admissions during or after pregnancy and to compare the characteristics of these women's first and second ICU admissions. METHODS A descriptive analysis from the French national hospital discharge database that included all women admitted to an ICU during pregnancy or within 42 days after delivery, between 2010 and 2014. RESULTS During the 5-year study period, there were 371 women with more than one maternal ICU admission, representing 2.5% of all women admitted during or after pregnancy (371/15,096) and a 0.9 per 10,000 deliveries (371/4,030,409) rate of repeated maternal ICU admission. Compared with women with only one maternal ICU admission, those with repeated maternal ICU admissions were more often admitted during the pregnancy rather than during or after the delivery stay (P < 0.001), for organ failure or sepsis (P < 0.001), and with a SAPS-II score >25 (P < 0.001). Women with repeated admissions were usually readmitted for the same indications and had similar SAPS-II scores. Half of ICU readmissions occurred within 72 hours of first ICU discharge, with similar causes and levels of severity for both stays. CONCLUSION Although the rate of women with repeated maternal ICU admissions was low, their initial stay had a specific profile of causes of admission and greater severity compared with the stay of women admitted only once. The pattern and similar characteristics of both first and second ICU admission and the short interval for readmission suggests that some ICU discharges may have been potentially premature.
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Affiliation(s)
- Anne Alice Chantry
- Université de Paris, Centre of Research in Epidemiology and Statistics/CRESS/Obstetrical Paediatric and Perinatal Epidemiology Research Team (EPOPé), INSERM, INRA, 53 avenue de l'observatoire, 75014 Paris, France; Baudelocque Midwifery School, AP-HP, Université de Paris, 89 rue d'Assas, 75006 Paris, France.
| | - Clémence Monnet
- Université de Paris, Centre of Research in Epidemiology and Statistics/CRESS/Obstetrical Paediatric and Perinatal Epidemiology Research Team (EPOPé), INSERM, INRA, 53 avenue de l'observatoire, 75014 Paris, France
| | - Jeanne Fresson
- Université de Paris, Centre of Research in Epidemiology and Statistics/CRESS/Obstetrical Paediatric and Perinatal Epidemiology Research Team (EPOPé), INSERM, INRA, 53 avenue de l'observatoire, 75014 Paris, France; Department of Medical Information, Nancy University Hospital, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Daphnis Miller
- Université de Paris, Centre of Research in Epidemiology and Statistics/CRESS/Obstetrical Paediatric and Perinatal Epidemiology Research Team (EPOPé), INSERM, INRA, 53 avenue de l'observatoire, 75014 Paris, France
| | - Marie-Pierre Bonnet
- Université de Paris, Centre of Research in Epidemiology and Statistics/CRESS/Obstetrical Paediatric and Perinatal Epidemiology Research Team (EPOPé), INSERM, INRA, 53 avenue de l'observatoire, 75014 Paris, France; Anaesthesia and Critical Care Department, Trousseau Hospital, DMU DREAM, APHP, 26 avenue du docteur Netter, 75012 Paris, France
| | - Catherine Deneux-Tharaux
- Université de Paris, Centre of Research in Epidemiology and Statistics/CRESS/Obstetrical Paediatric and Perinatal Epidemiology Research Team (EPOPé), INSERM, INRA, 53 avenue de l'observatoire, 75014 Paris, France
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Challine A, Voron T, Dousset B, Creavin B, Katsahian S, Parc Y, Lazzati A, Lefèvre JH. Postoperative outcomes after laparoscopic or open gastrectomy. A national cohort study of 10,343 patients. Eur J Surg Oncol 2021; 47:1985-1995. [PMID: 34078568 DOI: 10.1016/j.ejso.2021.05.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/15/2021] [Accepted: 05/17/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Laparoscopy for gastric cancer has not been as popular compared with other digestive surgeries, with conflicting reports on outcomes. The aim of this study focuses on the surgical techniques comparing open and laparoscopy by assessing the morbi-mortality and long-term complications after gastrectomy. METHODS A retrospective study (2013-2018) was performed on a prospective national cohort (PMSI). All patients undergoing resection for gastric cancer with a partial gastrectomy (PG) or total gastrectomy (TG) were included. Overall morbidity at 90 post-operative days and long-term results were the main outcomes. The groups (open and laparoscopy) were compared using a propensity score and volume activity matching after stratification on resection type (TG or PG). RESULTS A total of 10,343 patients were included. The overall 90-day mortality and morbidity were 7% and 45%, with reintervention required in 9.1%. High centre volume was associated with improved outcomes. There was no difference in population characteristics between groups after matching. An overall benefit for a laparoscopic approach after PG was found for morbidity (Open = 39.4% vs. Laparoscopy = 32.6%, p = 0.01), length of stay (Open = 14[10-21] vs. Laparoscopy = 11[8-17] days, p<0.0001). For TG, increased reintervention rate (Open = 10.8% vs. Laparoscopy = 14.5%, p = 0.04) and increased oesophageal stricture rate (HR = 2.54[1.67-3.85], p<0.001) were encountered after a laparoscopic approach. No benefit on mortality was found for laparoscopic approach in both type of resections after adjusted analysis. CONCLUSIONS Laparoscopy is feasible for PG with a substantial benefit on morbidity and length of stay, however, laparoscopic TG should be performed with caution, with of higher rates of reintervention and oesophageal stricture.
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Affiliation(s)
- Alexandre Challine
- Department of Digestive Surgery, APHP, Hôpital Cochin, Paris, France; Université de Paris, France; INSERM UMR 1138 Team 22, Centre de Recherche des Cordeliers, France
| | - Thibault Voron
- Department of Digestive Surgery, AP-HP, Hôpital, Saint Antoine, F-75012, Paris, France; Sorbonne Université, France
| | - Bertrand Dousset
- Department of Digestive Surgery, APHP, Hôpital Cochin, Paris, France; Université de Paris, France
| | - Ben Creavin
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Sandrine Katsahian
- Université de Paris, France; INSERM UMR 1138 Team 22, Centre de Recherche des Cordeliers, France; Department of Biostatics, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Yann Parc
- Department of Digestive Surgery, AP-HP, Hôpital, Saint Antoine, F-75012, Paris, France; Sorbonne Université, France
| | - Andrea Lazzati
- Université de Paris, France; INSERM UMR 1138 Team 22, Centre de Recherche des Cordeliers, France; Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Creteil, France
| | - Jérémie H Lefèvre
- Department of Digestive Surgery, AP-HP, Hôpital, Saint Antoine, F-75012, Paris, France; Sorbonne Université, France.
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Olié V, Moutengou E, Grave C, Deneux-Tharaux C, Regnault N, Kretz S, Gabet A, Mounier-Vehier C, Tsatsaris V, Plu-Bureau G, Blacher J. Prevalence of hypertensive disorders during pregnancy in France (2010-2018): The Nationwide CONCEPTION Study. J Clin Hypertens (Greenwich) 2021; 23:1344-1353. [PMID: 34042277 PMCID: PMC8678732 DOI: 10.1111/jch.14254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/10/2021] [Accepted: 03/28/2021] [Indexed: 01/19/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) are one of the leading causes of maternal and fetal morbidity and mortality. We aimed to estimate the prevalence of each HDP in France and to study their associations. All pregnant women who delivered in France between 2010 and 2018 were included in a cohort and followed during their pregnancy and 6 weeks of postpartum. Each HDP occurring during the follow-up was identified. Prevalence of each HDP and cumulative incidence by gestational age were estimated. Incidence rate ratio (IRR) and 95% confidence interval (CI) for preeclampsia among women with preexisting or gestational hypertension (GH) were estimated using Poisson regression and adjusted for age were estimated. Between 2010 and 2018, 6 302 810 deliveries were included. HDP complicated 7.4% of pregnancies. Preeclampsia and GH complicated 2.0% and 4.2% of pregnancies, respectively. Most of preeclampsia cases occurred without a prior HDP. HELLP syndrome represented 10.4% of preeclampsia cases. Compared to nulliparous pregnancies without HDP prior preeclampsia, the age-adjusted IRR of preeclampsia was 6.2 [95% CI: 6.1-6.4] in nulliparous pregnancies with preexisting hypertension and 2.9 [95% CI: 2.8-3.0] in nulliparous pregnancies with GH. In France, HDP occurred in 7.4% of all pregnancies. Women with preexisting chronic hypertension are at high risk to present preeclampsia during pregnancy. Preeclampsia complicated 2.0% of pregnancies in France. Tailoring management of women according to the HDP is a major challenge to avoid complications related to these disorders.
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Affiliation(s)
- Valérie Olié
- Santé publique France, the French Public Health Agency, Saint-Maurice, France
| | - Elodie Moutengou
- Santé publique France, the French Public Health Agency, Saint-Maurice, France
| | - Clémence Grave
- Santé publique France, the French Public Health Agency, Saint-Maurice, France
| | - Catherine Deneux-Tharaux
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), France.,Paris-Descartes University, Paris, France
| | - Nolwenn Regnault
- Santé publique France, the French Public Health Agency, Saint-Maurice, France
| | - Sandrine Kretz
- Diagnosis and Therapeutic Center, AP-HP, University Paris Descartes, Paris, France
| | - Amélie Gabet
- Santé publique France, the French Public Health Agency, Saint-Maurice, France
| | - Claire Mounier-Vehier
- Vascular Medicine and Hypertension Center, EA 2694 - Santé Publique- University Lille, Lille, France
| | - Vassilis Tsatsaris
- Paris-Descartes University, Paris, France.,Department of Obstetrics and Gynecology, APHP, Port-Royal Maternity, University Hospital Center Cochin Broca Hôtel Dieu, Groupe Hospitalier Universitaire Ouest, Paris, France
| | - Geneviève Plu-Bureau
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), France.,Paris-Descartes University, Paris, France.,Division of Gynaecology, APHP, Hôpital Cochin, Paris, France
| | - Jacques Blacher
- Paris-Descartes University, Paris, France.,Diagnosis and Therapeutic Center, AP-HP, University Paris Descartes, Paris, France
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Failure to rescue following proctectomy for rectal cancer: the additional benefit of laparoscopic approach in a nationwide observational study of 44,536 patients. Surg Endosc 2021; 36:435-445. [PMID: 33871717 DOI: 10.1007/s00464-021-08303-6] [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: 09/06/2020] [Accepted: 01/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is growing evidence that failure to rescue (FTR) is an important factor of postoperative mortality (POM) after rectal cancer surgery and surgical approach modified post-operative outcomes. However, the impact of laparoscopy on FTR after proctectomy for rectal cancer remains unknown. The aim of this study was to compare the rates of postoperative complications and FTR after laparoscopy vs open proctectomy for cancer. METHODS All patients who underwent proctectomy for rectal cancer between 2012 and 2016 were included. FTR was defined as the 90-day POM rate among patients with major complications. Outcomes of patients undergoing open or laparoscopic rectal cancer surgery were compared after 1:1 propensity score matching by year of surgery, hospital volume, sex, age, Charlson score, neoadjuvant chemotherapy, tumor localization and type of anastomosis. RESULTS Overall, 44,536 patients who underwent proctectomy were included, 7043 of whom (15.8%) developed major complications. The rates of major complications, POM and FTR were significantly higher in open compared to laparoscopic procedure (major complications: 19.2% vs 13.7%, p < 0.001; POM: 5.4% vs 2.3%, p < 0.001; FTR: 13.6% vs 8.3%, p < 0.001; respectively). After matching, open and laparoscopic groups were comparable. Multivariate analysis showed that age, Charlson score, sphincter-preserving procedure and surgical approach were predictive factors for FTR. Open proctectomy was found to be a risk factor for FTR (OR 1.342, IC95% [1.066; 1.689], p = 0.012) compared to laparoscopic procedure. CONCLUSION When complications occurred, patients operated on by open proctectomy were more likely to die.
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Demiguel V, Blondel B, Bonnet C, Nguyen-Thanh V, Saurel-Cubizolles MJ, Regnault N. Trends in Tobacco Smoking in Pregnant Women: Data From French National Perinatal Surveys. Int J Public Health 2021; 66:602873. [PMID: 34744568 PMCID: PMC8565271 DOI: 10.3389/ijph.2021.602873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/11/2021] [Indexed: 01/04/2023] Open
Abstract
Objectives: To describe maternal smoking trends in France between 1972 and 2016, and identify whether maternal characteristics associated with smoking in the 3rd trimester of pregnancy evolved between 2010 and 2016. Methods: Using French National Perinatal Surveys, we estimated proportions of smokers and the number of cigarettes smoked both just before pregnancy and during the 3rd trimester from 1972 to 2016. We used a Poisson model with robust variance to estimate prevalence ratios for smoking during pregnancy. Results: Proportions of mothers quitting smoking were relatively stable (46.0% in 1972 and 45.8% in 2016). The number of cigarettes smoked just before pregnancy and in the 3rd trimester decreased from 1995 onward. However, proportions of smokers remained high before (30.1%) and during the 3rd trimester in 2016 (16.2%). Smoking in the 3rd trimester was associated with a lower education level and lower income in both 2010 and 2016, whereas the association with age, country of birth and parity varied according to the survey year. Conclusion: Early targeted interventions are needed for smokers who plan to have a child and must take smokers' characteristics during pregnancy into account.
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Affiliation(s)
- Virginie Demiguel
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Béatrice Blondel
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- INSERM U1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Paris, France
| | - Camille Bonnet
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- INSERM U1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Paris, France
| | - Viêt Nguyen-Thanh
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Marie-Josèphe Saurel-Cubizolles
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- INSERM U1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Paris, France
| | - Nolwenn Regnault
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
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Meyer A, Fermaut M, Drouin J, Carbonnel F, Weill A. Drug use for gastrointestinal symptoms during pregnancy: A French nationwide study 2010-2018. PLoS One 2021; 16:e0245854. [PMID: 33481904 PMCID: PMC7822332 DOI: 10.1371/journal.pone.0245854] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/10/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To describe drug prescription for gastrointestinal symptoms during pregnancy. METHODS Using the French national health database, we identified pregnancies ending with a birth between April 2010 and December 2018, in France. We studied prescription of antacids, antispasmodics, antinauseants, laxatives and antidiarrheals during pregnancy, between two trimesters before and two trimesters after delivery. We also assessed hospitalization for gastrointestinal symptoms during pregnancy. RESULTS Among 6,365,471 pregnancies, 4,452,779 (74.0%) received at least one gastrointestinal drug during pregnancy; 2,228,275 (37.0%) received an antacid, 3,096,858 (51.5%) an antispasmodic, 1,861,731 (31.0%) an antinauseant, 919,116 (15.3%) a laxative and 617,808 (10.3%) an antidiarrheal. Prescription of proton pump inhibitors doubled from 12.2% in 2010 to 26.0% in 2018, while domperidone use decreased from 18.3% in 2010 to 2.2% in 2018. In addition, prescription of antacids increased from 7.0% during the trimester before pregnancy to 11.8% during the 1st trimester, 17.0% during the 2nd trimester and 23.4% during the 3rd trimester. Antispasmodic use was 10.6% during the trimester before pregnancy, 23.1% during the 1st trimester, 25.2% during the 2nd trimester and 24.0% during the 3rd trimester. Prescription of antinauseant drugs increased from 5.0% during the trimester before pregnancy to 25.7% during the 1st trimester, then decreased to 6.4% during the 2nd trimester and 3.2% during the 3rd trimester. Nausea/vomiting was the most common cause of hospitalization for gastrointestinal symptoms or diseases during pregnancy, although it accounted for only 1.0% of pregnancies. CONCLUSIONS Approximately three-quarters of women use drugs for gastrointestinal symptoms during pregnancy in France. Prescription of gastrointestinal drugs during pregnancy should be the subject of more detailed risk-benefit assessment and recommendations.
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Affiliation(s)
- Antoine Meyer
- GIS-EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, 42 bd de la Libération, Saint Denis, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Université Paris Sud, Le Kremlin Bicêtre, France
| | - Marion Fermaut
- Assistance Publique-Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Jérôme Drouin
- GIS-EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, 42 bd de la Libération, Saint Denis, France
| | - Franck Carbonnel
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Université Paris Sud, Le Kremlin Bicêtre, France
| | - Alain Weill
- GIS-EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, 42 bd de la Libération, Saint Denis, France
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Challine A, Dousset B, de'Angelis N, Lefèvre JH, Parc Y, Katsahian S, Lazzati A. Impact of coronavirus disease 2019 (COVID-19) lockdown on in-hospital mortality and surgical activity in elective digestive resections: A nationwide cohort analysis. Surgery 2021; 170:1644-1649. [PMID: 33597086 PMCID: PMC7834914 DOI: 10.1016/j.surg.2020.12.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/19/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
Background The outbreak of coronavirus disease 2019 (COVID-19) infection has led to the reorganization of hospital care in several countries. The objective was to report the postoperative mortality after elective digestive resections in a nationwide cohort during the lockdown period. Methods This analytic study was performed using a national billing database (the Programme de Médicalisation des Systèmes d’Informations). Patients who underwent elective digestive resections were divided in 2 groups: the lockdown group defined by hospital admissions between March 17 and May 11, 2020; and the control group, defined by hospital admissions during the corresponding period in 2019. Groups were matched on propensity score, geographical region, and surgical procedure. The primary outcome was the postoperative mortality. Results The overall population included 15,217 patients: 9,325 patients in the control group and 5,892 in the lockdown group. The overall surgical activity was decreased by 37% during the lockdown period. The overall in-hospital mortality during the hospital stay was 2.7%. After matching and adjustment, no difference in mortality between groups was reported (OR = 1.05; 95% CI: 0.83–1.34; P = .669). An asymptomatic COVID-19 infection was a risk factor for a 2-fold increased mortality, whereas a symptomatic COVID-19 infection was associated with a 10-fold increased mortality. Conclusion Despite a considerable reduction in the surgical activity for elective digestive resections during the lockdown period, mortality remained stable on a nationwide scale in COVID-free patients. These findings support that systematic COVID-19 screening should be advocated before elective gastrointestinal surgery and that all efforts should be made to maintain elective surgical resection for cancer during the second wave in COVID-free patients.
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Affiliation(s)
- Alexandre Challine
- Department of Digestive, Hepato-biliary, and Endocrine Surgery, University of Paris, Cochin Hospital, Paris, France; University of Paris, Centre de Recherche des Cordeliers, Paris, France.
| | - Bertrand Dousset
- Department of Digestive, Hepato-biliary, and Endocrine Surgery, University of Paris, Cochin Hospital, Paris, France
| | - Nicola de'Angelis
- Department of Digestive Surgery, University Paris Est-UPEC, Henri Mondor University Hospital, Créteil, France
| | - Jérémie H Lefèvre
- Department of Digestive and General Surgery, Sorbonne University, Saint-Antoine Hospital, Paris, France. https://twitter.com/jeremielefevre
| | - Yann Parc
- Department of Digestive and General Surgery, Sorbonne University, Saint-Antoine Hospital, Paris, France
| | - Sandrine Katsahian
- Epidemiology Department, University of Paris, European Hospital Georges Pompidou, Paris, France
| | - Andrea Lazzati
- Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France; University Paris Est-UPEC, Créteil, France
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Clesse C, Cottenet J, Lighezzolo-Alnot J, Goueslard K, Scheffler M, Sagot P, Quantin C. Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries. Sci Rep 2020; 10:20208. [PMID: 33214621 PMCID: PMC7677317 DOI: 10.1038/s41598-020-70881-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/28/2020] [Indexed: 02/08/2023] Open
Abstract
Episiotomy use has decreased due to the lack of evidence on its protective effects from maternal obstetric anal sphincter injuries. Indications for episiotomy vary considerably and there are a great variety of factors associated with its use. The aim of this article is to describe the episiotomy rate in France between 2013 and 2017 and the factors associated with its use in non-operative vaginal deliveries. In this retrospective population-based cohort study, we included vaginal deliveries performed in French hospitals (N = 584) and for which parity was coded. The variable of interest was the rate of episiotomy, particularly for non-operative vaginal deliveries. Trends in the episiotomy rates were studied using the Cochran-Armitage test. Hierarchical logistic regression was used to identify variables associated with episiotomy according to maternal age and parity. Between 2013 and 2017, French episiotomy rates fell from 21.6 to 14.3% for all vaginal deliveries (p < 0.01), and from 15.5 to 9.3% (p < 0.01) for all non-operative vaginal deliveries. Among non-operative vaginal deliveries, epidural analgesia, non-reassuring fetal heart rate, meconium in the amniotic fluid, shoulder dystocia, and newborn weight (≥ 4,000 g) were risk factors for episiotomy, both for nulliparous and multiparous women. On the contrary, prematurity reduced the risk of its use. For nulliparous women, breech presentation was also a risk factor for episiotomy, and for multiparous women, scarred uterus and multiple pregnancies were risk factors. In France, despite a reduction in episiotomy use over the last few years, the factors associated with episiotomy have not changed and are similar to the literature. This suggests that the decrease in episiotomies in France is an overall tendency which is probably related to improved care strategies that have been relayed by hospital teams and perinatal networks.
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Affiliation(s)
- Christophe Clesse
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary, University of London, Old Anatomy Building Charterhouse Square, London, EC1M 6BQ, UK.,Interpsy Laboratory (EA 4432), Universite de Lorraine - Campus Lettres Et Sciences Humaines, Nancy, France.,Majorelle Polyclinic, Nancy, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, University of Burgundy and Franche-Comté, Dijon, France
| | | | - Karine Goueslard
- Biostatistics and Bioinformatics (DIM), University Hospital, University of Burgundy and Franche-Comté, Dijon, France
| | - Michele Scheffler
- Obstetricial Gynecologist, Endocrinologist, Gynecologist, The FNCGM (National Federation of Gynecology Medical Colleges), Cabinet de Gynécologie Médicale Et Obstétrique, 21 avenue Foch, 54000, Nancy, France
| | - Paul Sagot
- Department of Obstetrics and Gynecology, University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, University of Burgundy and Franche-Comté, Dijon, France. .,Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, Dijon, France. .,Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France.
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Centralization and Oncologic Training Reduce Postoperative Morbidity and Failure-to-rescue Rates After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies: Study on a 10-year National French Practice. Ann Surg 2020; 272:847-854. [PMID: 32833761 DOI: 10.1097/sla.0000000000004326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Evaluate at a national level the postoperative mortality (POM), major morbidity (MM) and failure-to-rescue (FTR) after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) across time and according to hospital-volume. BACKGROUND CRS/HIPEC is an effective therapeutic strategy commonly used to treat peritoneal surface malignancies. However, this aggressive approach has the reputation to be associated with a high POM and MM. METHODS All patients treated with CRS/HIPEC between 2009 and 2018 in France were identified through a national medical database. Patients and perioperative outcomes were analyzed. A cut-off value of the annual CRS/HIPEC caseload affecting the 90-day POM was calculated using the Chi-squared Automatic Interaction Detector method. A multivariable logistic model was used to identify factors mediating 90-day POM. RESULTS A total of 7476 CRS/HIPEC were analyzed. Median age was 59 years with a mean Elixhauser comorbidity index of 3.1, both increasing over time (P < 0.001). Ninety-day POM was 2.6%. MM occurred in 44.2% with a FTR rate of 5.1%. The threshold of CRS/HIPEC number per center per year above which the 90-day POM was significantly reduced was 45 (3.2% vs 1.9%, P = 0.01). High-volume centers had more extended surgery (P < 0.001) with increased MM (55.8% vs 40.4%, P < 0.001) but lower FTR (3.1% vs 6.3%, P = 0.001). After multivariate analysis, independent factors associated with 90-day POM were: age >70 years (P = 0.002), Elixhauser comorbidity index ≥8 (P = 0.006), lower gastro-intestinal origin, (P < 0.010), MM (P < 0.001), and <45 procedures/yr (P = 0.002). CONCLUSION In France, CRS/HIPEC is a safe procedure with an acceptable 90-day POM that could even be improved through centralization in high-volume centers.
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Barataud-Reilhac A, Kerbrat S, Roux J, Guilleux A, Polard E, Leray E. Teriflunomide-exposed pregnancies in a French cohort of patients with multiple sclerosis. Neurol Clin Pract 2020; 10:287-297. [PMID: 32983608 DOI: 10.1212/cpj.0000000000000717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 11/15/2022]
Abstract
Objective To describe pregnancies exposed to teriflunomide (TERIF) in women with multiple sclerosis (MS) in France over the period 2014-2016. Methods All 15- to 49-year-old women with MS in the national health insurance database were included. Pregnancies that had started between August 2014 and March 2016 were identified from their outcomes. Three groups according to treatment exposure were compared: TERIF, interferons (IFNs) or glatiramer acetate, and no medication. Results Among the 44,008 women with MS followed 24.5 months on average, 2,639 pregnancies were identified. There were 1,538 pregnancies (58.3%) that were not exposed to any MS treatment in accordance with the guidelines. A total of 673 pregnancies (25.5%) were exposed to IFN and/or glatiramer acetate, and possible or probable exposure to contra-indicated treatments was observed in 428 pregnancies (16.2%), of whom 47 pregnancies were exposed to TERIF. The annual incidence rate of pregnancies exposed to TERIF was 1.4 per 100 patient-years; i.e., 3 times less than the 2 control groups (5.6 and 4.7, respectively). The median exposure duration to TERIF was 45 days after conception. The outcomes comprised 23 live births, 22 abortions (3 times more than the 2 other groups), and 2 miscarriages. All newborns were healthy at birth. Conclusions Despite specific TERIF guidelines for pregnancy-related issues and the availability of alternative therapies, some pregnancies exposed to TERIF were identified. Most of the cases were because of the absence of the recommended accelerated elimination procedure and appeared to be mostly unplanned pregnancies that probably reflect a lack of effective contraception.
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Affiliation(s)
- Astrid Barataud-Reilhac
- Ecole des Hautes Etudes en Santé Publique (EHESP) (AB-R, JR, AG, EL), Département METIS, F-35043 Rennes, France; Univ Rennes (SK, JR, AG, EP, EL), EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, F-35000 Rennes, France; and Service de Pharmacovigilance (EP), CHU Rennes, F-35000 Rennes, France
| | - Sandrine Kerbrat
- Ecole des Hautes Etudes en Santé Publique (EHESP) (AB-R, JR, AG, EL), Département METIS, F-35043 Rennes, France; Univ Rennes (SK, JR, AG, EP, EL), EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, F-35000 Rennes, France; and Service de Pharmacovigilance (EP), CHU Rennes, F-35000 Rennes, France
| | - Jonathan Roux
- Ecole des Hautes Etudes en Santé Publique (EHESP) (AB-R, JR, AG, EL), Département METIS, F-35043 Rennes, France; Univ Rennes (SK, JR, AG, EP, EL), EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, F-35000 Rennes, France; and Service de Pharmacovigilance (EP), CHU Rennes, F-35000 Rennes, France
| | - Alice Guilleux
- Ecole des Hautes Etudes en Santé Publique (EHESP) (AB-R, JR, AG, EL), Département METIS, F-35043 Rennes, France; Univ Rennes (SK, JR, AG, EP, EL), EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, F-35000 Rennes, France; and Service de Pharmacovigilance (EP), CHU Rennes, F-35000 Rennes, France
| | - Elisabeth Polard
- Ecole des Hautes Etudes en Santé Publique (EHESP) (AB-R, JR, AG, EL), Département METIS, F-35043 Rennes, France; Univ Rennes (SK, JR, AG, EP, EL), EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, F-35000 Rennes, France; and Service de Pharmacovigilance (EP), CHU Rennes, F-35000 Rennes, France
| | - Emmanuelle Leray
- Ecole des Hautes Etudes en Santé Publique (EHESP) (AB-R, JR, AG, EL), Département METIS, F-35043 Rennes, France; Univ Rennes (SK, JR, AG, EP, EL), EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, F-35000 Rennes, France; and Service de Pharmacovigilance (EP), CHU Rennes, F-35000 Rennes, France
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Referring Patients to Expert Centers After Pancreatectomy Is Too Late to Improve Outcome. Inter-hospital Transfer Analysis in Nationwide Study of 19,938 Patients. Ann Surg 2020; 272:723-730. [DOI: 10.1097/sla.0000000000004342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Araujo M, Hurault-Delarue C, Sommet A, Damase-Michel C, Benevent J, Lacroix I. Drug prescriptions in French pregnant women between 2015 and 2016: A study in the EGB database. Therapie 2020; 76:239-247. [PMID: 32736872 DOI: 10.1016/j.therap.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe drug prescriptions in pregnant women in France and to identify teratogenic and fetotoxic drug prescriptions. METHODS This study was carried out using data from Échantillon Généraliste des Bénéficiaires (EGB), a French national health database which includes 1/97th of the French population. Our study population included all pregnant women, aged 10 to 60, who were registered in the EGB and had a pregnancy outcome between 2015 and 2016. Drugs prescribed and dispensed to women during pregnancy and the 3 months before, were collected and described for each year and according to pregnancy trimesters. Prescriptions of major teratogen or fetotoxic drugs were described. RESULTS We identified 18,279 pregnancies. Among them, 93% received drug prescriptions and dispensations during pregnancy with an average of 7.4±5.5 different drugs. "Alimentary tract and metabolism (75.4%)", "nervous system (64.0%)" and "blood and blood forming organs (58.7%)" classes were the most frequently prescribed to pregnant women. The 5 most frequently prescribed drugs were paracetamol (60.6%), iron (49.2%), folic acid (45.6%), phloroglucinol (44.0%) and colecalciferol (41.4%). The most commonly prescribed drugs included some that have not yet been well evaluated in pregnancy. Prescriptions and dispensations of teratogenic or fetotoxic drugs, as Non-Steroidal Anti-Inflammatory Drugs and retinoids were observed. Valproic acid prescriptions to pregnant women have become extremely rare. CONCLUSION This descriptive study demonstrates that numerous drugs are prescribed and dispensed to pregnant women in France. These include drugs with a proven teratogenic or fetotoxic effect and many drugs that have not yet been well evaluated in pregnancy.
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Affiliation(s)
- Mélanie Araujo
- Réseau REGARDS, Laboratoire de Pharmacologie Médicale et Clinique (Medical, Clinical Pharmacology Laboratory), Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital Centre), INSERM UMR 1027, Faculté de Médecine de Toulouse (Toulouse Faculty of Medicine), 37 allées Jules-Guesde, 31000, Toulouse, France.
| | - Caroline Hurault-Delarue
- Réseau REGARDS, Laboratoire de Pharmacologie Médicale et Clinique (Medical, Clinical Pharmacology Laboratory), Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital Centre), INSERM UMR 1027, Faculté de Médecine de Toulouse (Toulouse Faculty of Medicine), 37 allées Jules-Guesde, 31000, Toulouse, France
| | - Agnès Sommet
- Réseau REGARDS, Laboratoire de Pharmacologie Médicale et Clinique (Medical and Clinical Pharmacology Laboratory), CIC 1436, Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital Centre), INSERM UMR 1027, Faculté de Médecine de Toulouse (Toulouse Faculty of Medicine), 37 allées Jules-Guesde, 31000, Toulouse, France
| | - Christine Damase-Michel
- Réseau REGARDS, Laboratoire de Pharmacologie Médicale et Clinique (Medical, Clinical Pharmacology Laboratory), Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital Centre), INSERM UMR 1027, Faculté de Médecine de Toulouse (Toulouse Faculty of Medicine), 37 allées Jules-Guesde, 31000, Toulouse, France
| | - Justine Benevent
- Réseau REGARDS, Laboratoire de Pharmacologie Médicale et Clinique (Medical, Clinical Pharmacology Laboratory), Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital Centre), INSERM UMR 1027, Faculté de Médecine de Toulouse (Toulouse Faculty of Medicine), 37 allées Jules-Guesde, 31000, Toulouse, France
| | - Isabelle Lacroix
- Réseau REGARDS, Laboratoire de Pharmacologie Médicale et Clinique (Medical, Clinical Pharmacology Laboratory), Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital Centre), INSERM UMR 1027, Faculté de Médecine de Toulouse (Toulouse Faculty of Medicine), 37 allées Jules-Guesde, 31000, Toulouse, France
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Impact of national guidelines on the cesarean delivery rate in France: A 2010-2016 comparison using the Robson classification. Eur J Obstet Gynecol Reprod Biol 2020; 252:359-365. [PMID: 32682210 DOI: 10.1016/j.ejogrb.2020.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE French national guidelines on indications of pre-labor cesarean delivery and management of women with a previous cesarean delivery (CD) were published in 2012. Our aim was to assess if these guidelines have impacted the global CD rate in France and the CD rate in specific groups according to the Robson classification, using the national perinatal population-based surveys of 2010 and 2016. METHODS Women included in the French National Perinatal Surveys in 2010 and 2016 were classified using maternal characteristics and obstetrical history in 12 groups according to Robson's classification (N = 14176 in 2010 and N = 13057 in 2016). We estimated relative size, CD rate and contribution of each group to the global CD rate in 2010 and 2016. Then, we compared the 2 survey years. We analyzed the population characteristics, timing and indications of CD in the groups with significant changes between the two survey years. RESULTS The global CD rate was 20.5 % in 2010 and 19.5 % in 2016 (p = 0.027), with a lower pre-labor CD rate (10.9 % versus 9.2 %, p < 0.001). Despite an increasing of maternal age in 2016, we observed a decrease of the relative size of group 2b (nulliparous, singleton, cephalic, term, pre-labor CD): 1.1 % in 2010 versus 0.8 % in 2016 (p = 0.008). Group 5 (previous CD, singleton, cephalic, ≥37 weeks) was the higher contributor to the global CD rate in both 2010 and 2016 (contribution: 5.8 % of the 20.5 % CD rate and 5.4 % of the 19.5 % CD rate, respectively). Despite an increase of BMI in this group, its CD rate significantly decreased between the two years (61.2 % in 2010 versus 55.1 % in 2016, p = 0.001). CONCLUSION In France, CD rates have decreased between 2010 and 2016, among women having a pre-labor CD and women with a previous CD, in accordance with national guidelines. National guidelines can help mode of delivery decision-making of physicians and impact the national CD rates.
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Predictive factors for utilization of a low-volume center in pancreatic surgery: A nationwide study. J Visc Surg 2020; 158:125-132. [PMID: 32595025 DOI: 10.1016/j.jviscsurg.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE It has been demonstrated that mortality following pancreatectomy is correlated with surgical volume. However, up until now, no French study has focused on predictive factors to undergo pancreatectomy in low-volume centers. The objective of this study is to analyze the clinical characteristics, socio-economic status and medical density according to surgical volume and to analyze predictive factors for undergoing pancreatectomy in low-volume centers. PATIENTS AND METHODS All patients who underwent pancreatectomy in France from 2012 to 2015 were identified fromthe PMSI database. Hopsitals were classified as low, intermediate and high volume (<10, 11-19, ≥20 resections/year, respectively). Clinical and socioeconomic data, travel distance and rurality were assesed to identify factors associated with undergoing pancreatectomy at low-volume hospitals. RESULTS In overall, 12,333 patients were included. Those who underwent pancreatectomy in low-volume centers were more likely older, had high Charlson comorbidity index (CCI), had low socioeconomic status, and resided in rural locations.distance traveled by patients operated on in low-volume centers was significantly shorter (23 vs. 61km, P<0.001). In multivariable analysis, older age (P=0.04), CCI≥4 (P=0.008), short travel distance (P<0.001), low socio-economic status (P<0.001) and rurality (P<0.001) were associated withundergoing pancreatectomy in low-volume centers. CONCLUSION Patients continue to undergo pancreatectomy at low-volume hospitals is due not only to clinical parameters, but also to socioeconomic and environmental factors. These factors should be taken into account in process of pancreatic surgery centralization.
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von Theobald P, Bohrer M, Lorrain S, Iacobelli S. Risk factors associated with severe perineal tears: A five-year study. J Gynecol Obstet Hum Reprod 2020; 49:101820. [PMID: 32450305 DOI: 10.1016/j.jogoh.2020.101820] [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: 02/07/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Our aim was to describe risk factors associated with 34DPT in operative and non-operative vaginal deliveries, over a five-year period. STUDY DESIGN This was a retrospective cohort study including 39,227 vaginal deliveries from 2013 to 2017 in a single French University Hospital. Annual characteristics of the analyzed population were recorded. Univariate logistic regression was used to evaluate the association between these characteristics and 34DPT. Multivariate analysis was used to identify combinations of risk factors associated with instrumental delivery. RESULTS The rate of perineal tears was constantly rising but rate of 34DPT was stable, ranging between 0.8 and 1.4% over the study period. Cesarean section rate was stable between 18.8% and 19.6%. Rate of diabetes, preeclampsia and obesity (BMI < 40) was increasing and episiotomy rate decreasing (from 19.8% to 11.8%). Operative deliveries rate remained stable between 11 and 12.8%. Multivariate regression showed that gestational age over 39 weeks (aOR 1.18, 95% CI [1.02; 1.35]), birth weight over 3500 g (aOR 1.62, 95% CI [1.05; 2.49]) were associated with 34DPT in patients without operative vaginal deliveries but not episiotomy. Gestational age (aOR 1.71, 95% CI [1.18; 2.47]), episiotomy (aOR 0.55, 95% CI [0.38; 0.79]) and diabetes (aOR 1.73, 95% CI [1.15; 2.61]) were associated with 34DPT among patients with operative vaginal deliveries. CONCLUSION In a tertiary medical center model with low cesarean section rate, factors associated with 34DPT were different among patients with or without operative vaginal delivery. The question of the protective effect of mediolateral episiotomy against 34DPT in case of operative delivery deserves further investigations.
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Affiliation(s)
- P von Theobald
- Centre d'Études Périnatales de l'Océan Indien (CEPOI) - EA7388, Centre Hospitalier Universitaire de la Réunion, Saint-Pierre Cedex, La Réunion, France; Service de Gynécologie et Obstétrique, CHU de la Réunion, Hôpital Félix Guyon, Allée des Topazes, CS 11021, 97405 Saint Denis de La Réunion Cedex, France.
| | - M Bohrer
- Département d'Informatique Médicale, CHU de la Réunion, Hôpital Félix Guyon, Allée des Topazes, CS 11021, 97405 Saint Denis de La Réunion Cedex, France
| | - S Lorrain
- Centre d'Études Périnatales de l'Océan Indien (CEPOI) - EA7388, Centre Hospitalier Universitaire de la Réunion, Saint-Pierre Cedex, La Réunion, France
| | - S Iacobelli
- Centre d'Études Périnatales de l'Océan Indien (CEPOI) - EA7388, Centre Hospitalier Universitaire de la Réunion, Saint-Pierre Cedex, La Réunion, France; Réanimation Néonatale et Pédiatrique, Néonatologie, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre Cedex, La Réunion, France
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Thillard EM, Gautier S, Babykina E, Carton L, Amad A, Bouzillé G, Beuscart JB, Ficheur G, Chazard E. Psychiatric Adverse Events Associated With Infliximab: A Cohort Study From the French Nationwide Discharge Abstract Database. Front Pharmacol 2020; 11:513. [PMID: 32390850 PMCID: PMC7188945 DOI: 10.3389/fphar.2020.00513] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/01/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction Infliximab (IFX) was the first anti-tumor necrosis factor (TNFα) antibody to be used in the treatment of severe chronic inflammatory diseases, such as Crohn’s disease and rheumatoid arthritis. A number of serious adverse drug reactions are known to be associated with IFX use; they include infections, malignancies, and injection site reactions. Although a few case reports have described potential psychiatric adverse events (including suicide attempts and manic episodes), the latter are barely mentioned in IFX’s summary of product characteristics. The objective of the present retrospective study was to detect potential psychiatric adverse events associated with IFX treatment by analyzing a national discharge abstract database. Materials and Methods We performed an historical cohort study by analyzing data from the French national hospital discharge abstract database (PMSI) between 2008 and 2014. All patients admitted with one of the five diseases treated with IFX were included. Results Of the 325,319 patients included in the study, 7,600 had been treated with IFX. The proportion of hospital admissions for one or more psychiatric events was higher among IFX-exposed patients (750 out of 7,600; 9.87%) than among non-exposed patients (17,456 out of 317,719; 5.49%). After taking account of potential confounders in the cohort as a whole, a semi-parametric Cox regression analysis gave an overall hazard ratio (HR) [95% confidence interval] (CI) of 4.5 [3.95; 5.13] for a hospital admission with a psychiatric adverse event during treatment with IFX. The HR (95%CI) for a depressive disorder was 4.97 (7.35; 6.68). Even higher risks were observed for certain pairs of adverse events and underlying pathologies: psychotic disorders in patients treated for ulcerative colitis (HR = 5.43 [2.01; 14.6]), manic episodes in patients treated for severe psoriasis (HR = 12.6 [4.65; 34.2]), and suicide attempts in patients treated for rheumatoid arthritis (HR = 4.45 [1.11; 17.9]). Discussion The present retrospective, observational study confirmed that IFX treatment is associated with an elevated risk of psychiatric adverse events. Depending on the disease treated, physicians should be aware of these potential adverse events.
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Affiliation(s)
- Eve-Marie Thillard
- Univ. Lille, CHU Lille, ULR 2694, CERIM, Public Health Department, Lille, France
| | - Sophie Gautier
- Univ. Lille, Inserm, CHU Lille, UMR-S1172, Center for Pharmacovigilance, Lille, France
| | - Evgeniya Babykina
- Univ. Lille, CHU Lille, ULR 2694, CERIM, Public Health Department, Lille, France
| | - Louise Carton
- Univ. Lille, Inserm, CHU Lille, UMR_S1172, Medical Pharmacology Department, Lille, France
| | - Ali Amad
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Guillaume Bouzillé
- University of Rennes, Inserm, CHU Rennes, UMR 1099 - LTSI, Rennes, France
| | | | - Grégoire Ficheur
- Univ. Lille, CHU Lille, ULR 2694, CERIM, Public Health Department, Lille, France
| | - Emmanuel Chazard
- Univ. Lille, CHU Lille, ULR 2694, CERIM, Public Health Department, Lille, France
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Goueslard K, Cottenet J, Benzenine E, Tubert-Bitter P, Quantin C. Validation study: evaluation of the metrological quality of French hospital data for perinatal algorithms. BMJ Open 2020; 10:e035218. [PMID: 32404391 PMCID: PMC7228531 DOI: 10.1136/bmjopen-2019-035218] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of our validation study was to assess the metrological quality of hospital data for perinatal algorithms on a national level. DESIGN Validation study. SETTING This was a multicentre study of the French medicoadministrative database on perinatal indicators. PARTICIPANTS In each hospital, we selected 150 discharge abstracts for delivery (after 22 weeks of gestation), in 2014, and their corresponding medical records. Overall, 22 hospitals were included. INTERVENTIONS A single investigator performed blind data collection from medical records in order to compare data from discharge abstracts with data from medical records. Finally, 3246 discharge abstracts were studied. PRIMARY AND SECONDARY OUTCOME MEASURES Seventy items, including maternal and delivery characteristics and maternal morbidity, were collected for each delivery stay. RESULTS The concordance rate of maternal age at delivery was 94.8% (95% CI 93.8 to 95.4). Combining the two forms of pre-existing diabetes, the algorithm presented a PPV of 65.9% and a sensitivity of 75.7%. The concordance rate of gestational age at delivery was 91.8% (90.9 to 92.7). Regarding gestational diabetes, the PPV was 80.8% (79.4 to 82.2) and the sensitivity was 79.5% (78.1 to 80.9). Regardless of the algorithm explored, the PPV for vaginal delivery was over 99%. For the diagnosis codes corresponding to immediate postpartum haemorrhage, the PPV was 77.7% (76.3 to 79.1) and the sensitivity was 75.5% (74.0 to 77.0). The algorithm for stillbirth presented a PPV of 89.4% (88.3 to 90.5) and a sensitivity of 95.4% (94.7 to 96.1). CONCLUSIONS This first national validation study of many perinatal algorithms suggests that the French national hospital database is an appropriate data source for epidemiological studies, except for some indicators which presented low PPV and/or sensitivity.
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Affiliation(s)
- Karine Goueslard
- Biostatistics and Bioinformatics (DIM), Inserm, CIC 1432, Dijon, France
- University Hospital, Dijon, France
- Bourgogne Franche-Comté University, Dijon, France
- Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), Inserm, CIC 1432, Dijon, France
- University Hospital, Dijon, France
- Bourgogne Franche-Comté University, Dijon, France
- Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
| | - Eric Benzenine
- Biostatistics and Bioinformatics (DIM), Inserm, CIC 1432, Dijon, France
- University Hospital, Dijon, France
- Bourgogne Franche-Comté University, Dijon, France
- Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
| | - Pascale Tubert-Bitter
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, INSERM, Villejuif, Île-de-France, France
| | - Catherine Quantin
- Service de Biostatistique et Informatique Médicale, Centre Hospitalier Universitaire, Dijon, France
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Ben Ghezala I, Mariet A, Benzenine E, Bron AM, Baudin F, Daien V, Korobelnik J, Quantin C, Creuzot‐Garcher C. Incidence of acute postoperative endophthalmitis following macular surgery in France between 2006 and 2016. Acta Ophthalmol 2020; 98:e333-e338. [PMID: 31680475 DOI: 10.1111/aos.14279] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 09/26/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE To report the incidence of acute postoperative endophthalmitis (POE) after macular surgery in France between 2006 and 2016 and to identify associated factors. METHODS This retrospective database study included all hospital discharge records involving a surgical procedure for an epiretinal membrane or a macular hole in France from January 2006 to October 2016. Acute POE was identified by two codes in the tenth edition of the International Classification of Diseases within 42 days of a macular surgical procedure in the French national administrative database. RESULTS In France, 152 034 macular surgical procedures for epiretinal membranes or macular holes were recorded from 1 January 2006 to 31 October 2016. Suspected acute POE was reported in 381 cases. The incidence of POE was 0.25% overall, 0.30% for epiretinal membrane surgery and 0.14% for macular hole surgery. In multivariable Poisson regression analysis, epiretinal membrane surgery was associated with POE [incidence rate ratio (IRR), 2.24; 95% CI, 1.62-3.11; p < 0.001]. For epiretinal membrane surgery, the 2010-2011 period was significantly associated with a higher risk of POE (IRR, 1.66; 95% CI, 1.13-2.42; p = 0.03). CONCLUSION The incidence of POE after macular surgery was 0.25% overall in France between 2006 and 2016 and twice higher for epiretinal membrane surgery than for macular hole surgery. For epiretinal surgery only, the incidence of POE was higher in 2010-2011 (period of the switch to transconjunctival vitrectomy) than in the rest of the study period.
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Affiliation(s)
- Inès Ben Ghezala
- Department of Ophthalmology Dijon University Hospital Dijon France
| | - Anne‐Sophie Mariet
- CIC 1432 Inserm Dijon France
- Clinical Epidemiology/Clinical Trials Unit Clinical Investigation Center Dijon University Hospital Dijon France
- Biostatistics and Bioinformatics (DIM) University Hospital Dijon France
- Bourgogne Franche‐Comté University Dijon France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI) Inserm UVSQ Institut Pasteur Université Paris‐Saclay Paris France
| | - Eric Benzenine
- Biostatistics and Bioinformatics (DIM) University Hospital Dijon France
- Bourgogne Franche‐Comté University Dijon France
| | - Alain M. Bron
- Department of Ophthalmology Dijon University Hospital Dijon France
- Bourgogne Franche‐Comté University Dijon France
- Eye and Nutrition Research Group Bourgogne Franche‐Comté University Dijon France
| | - Florian Baudin
- Department of Ophthalmology Dijon University Hospital Dijon France
| | - Vincent Daien
- Department of Ophthalmology University Hospital of Montpellier Montpellier France
- Inserm, U1061 University of Montpellier Montpellier France
| | - Jean‐François Korobelnik
- Department of Ophthalmology University Hospital of Bordeaux Bordeaux France
- UMR 1219 Inserm Bordeaux Population Health Research Center Team LEHA University of Bordeaux Bordeaux France
| | - Catherine Quantin
- CIC 1432 Inserm Dijon France
- Clinical Epidemiology/Clinical Trials Unit Clinical Investigation Center Dijon University Hospital Dijon France
- Biostatistics and Bioinformatics (DIM) University Hospital Dijon France
- Bourgogne Franche‐Comté University Dijon France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI) Inserm UVSQ Institut Pasteur Université Paris‐Saclay Paris France
| | - Catherine Creuzot‐Garcher
- Department of Ophthalmology Dijon University Hospital Dijon France
- Bourgogne Franche‐Comté University Dijon France
- Eye and Nutrition Research Group Bourgogne Franche‐Comté University Dijon France
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Combier E, Roussot A, Chabernaud JL, Cottenet J, Rozenberg P, Quantin C. Out-of-maternity deliveries in France: A nationwide population-based study. PLoS One 2020; 15:e0228785. [PMID: 32092074 PMCID: PMC7039464 DOI: 10.1371/journal.pone.0228785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/22/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction In France, many maternity hospitals have been closed as a result of hospital restructuring in an effort to reduce costs through economies of scale. These closures have naturally increased the distance between home and the closest maternity ward for women throughout the country. However, studies have shown a positive correlation between this increase in distance and the incidence of unplanned out-of-maternity deliveries (OMD). This study was conducted to estimate the frequency of OMD in France, to identify the main risk factors and to assess their impact on maternal mortality and neonatal morbidity and mortality. Materials and methods We conducted a population-based observational retrospective study using data from 2012 to 2014 obtained from the French hospital discharge database. We included 2,256,797 deliveries and 1,999,453 singleton newborns in mainland France, among which, 6,733 (3.0‰) were OMD. The adverse outcomes were maternal mortality in hospital or during transport, stillbirth, neonatal mortality, neonatal hospitalizations, and newborn hypothermia and polycythemia. The socio-residential environment was also included in the regression analysis. Maternal and newborn adverse outcomes associated with OMD were analyzed with Generalized Estimating Equations regressions. Results The distance to the nearest maternity unit was the main factor for OMD. OMD were associated with maternal death (aRR 6.5 [1.6–26.3]) and all of the neonatal adverse outcomes: stillbirth (3.3 [2.8–3.8]), neonatal death (1.9 [1.2–3.1]), neonatal hospitalization (1.2 [1.1–1.3]), newborn hypothermia (5.9 [5.2–6.6]) and newborn polycythemia (4.8 [3.5–6.4]). Discussion In France, OMD increased over the study period. OMD were associated with all the adverse outcomes studied for mothers and newborns. Caregivers, including emergency teams, need to be better prepared for the management these at-risk cases. Furthermore, the increase in adverse outcomes, and the additional generated costs, should be considered carefully by the relevant authorities before any decisions are made to close or merge existing maternity units.
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Affiliation(s)
- Evelyne Combier
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Jean-Louis Chabernaud
- Neonatal and Pediatric Emergency Transport Team and NICU, Antoine-Beclere Hospital, AP-HP, Paris Saclay University, Clamart, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Patrick Rozenberg
- Versailles Saint-Quentin University, Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
- * E-mail:
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El Amrani M, Lenne X, Clement G, Delpero JR, Theis D, Pruvot FR, Bruandet A, Truant S. Specificity of Procedure volume and its Association With Postoperative Mortality in Digestive Cancer Surgery. Ann Surg 2019; 270:775-782. [DOI: 10.1097/sla.0000000000003532] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Desplanches T, Blondel B, Morgan AS, Burguet A, Kaminski M, Lecomte B, Marchand-Martin L, Rozé JC, Sagot P, Truffert P, Zeitlin J, Ancel PY, Fresson J. Volume of Neonatal Care and Survival without Disability at 2 Years in Very Preterm Infants: Results of a French National Cohort Study. J Pediatr 2019; 213:22-29.e4. [PMID: 31280891 DOI: 10.1016/j.jpeds.2019.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/10/2019] [Accepted: 06/03/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To investigate the relation between neonatal intensive care unit (NICU) volume and survival, and neuromotor and sensory disabilities at 2 years in very preterm infants. STUDY DESIGN The EPIPAGE-2 (Etude Epidémiologique sur les Petits Âges Gestationnels-2) national prospective population-based cohort study was used to include 2447 babies born alive in 66 level III hospitals between 24 and 30 completed weeks of gestation in 2011. The outcome was survival without disabilities (levels 2-5 of the Gross Motor Function Classification System for cerebral palsy with or without unilateral or bilateral blindness or deafness). Units were grouped in quartiles according to volume, defined as the annual admissions of very preterm babies. Multivariate logistic regression analyses with population average models were used. RESULTS Survival at discharge was lower in hospitals with lower volumes of neonatal activity (aOR 0.55, 95% CI 0.33-0.91). Survival without neuromotor and sensory disabilities at 2 years increased with hospital volume, from 75% to 80.7% in the highest volume units. After adjustment for gestational age, small for gestational age, sex, maternal age, infertility treatment, multiple pregnancy, principal cause of prematurity, parental socioeconomic status, and mother's country of birth, survival without neuromotor or sensory disabilities was significantly lower in hospitals with a lower volume of neonatal activity (aOR 0.60, 95% CI 0.38-0.95) than in the highest quartile hospitals. CONCLUSIONS These results suggest that lower neonatal intensive care unit volume is associated with lower survival without an increase in disabilities at 2 years. These results could be useful to generate improvements of perinatal regionalization.
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Affiliation(s)
- Thomas Desplanches
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France; CHRU Dijon, Department of Gynecology, Obstetrics, Fetal Medicine, and Infertility, University of Burgundy and Franche-Comté, Dijon, France.
| | - Béatrice Blondel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France
| | - Andrei Scott Morgan
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France
| | - Antoine Burguet
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France; Department of Neonatal Pediatrics, Dijon University Hospital, Dijon, France
| | - Monique Kaminski
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France
| | | | - Laetitia Marchand-Martin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France
| | - Jean-Christophe Rozé
- Pediatric Intensive Care Unit, Mothers' and Children's Hospital, Nantes Teaching Hospital, Nantes, France
| | - Paul Sagot
- CHRU Dijon, Department of Gynecology, Obstetrics, Fetal Medicine, and Infertility, University of Burgundy and Franche-Comté, Dijon, France
| | - Patrick Truffert
- Neonatal Intensive Care Unit, Jeanne de Flandre Hospital, CHRU Lille, Lille, France
| | - Jennifer Zeitlin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France
| | - Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France; Clinical Research Unit, Center for Clinical Investigation P1419, CHU Cochin Broca Hôtel-Dieu, Paris, France
| | - Jeanne Fresson
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France; CHRU Nancy, Department of Medical Information, Nancy, France
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Gouyon B, Martin-Mons S, Iacobelli S, Razafimahefa H, Kermorvant-Duchemin E, Brat R, Caeymaex L, Couringa Y, Alexandre C, Lafon C, Ramful D, Bonsante F, Binson G, Flamein F, Moussy-Durandy A, Di Maio M, Mazeiras G, Girard O, Desbruyeres C, Mourdie J, Escourrou G, Flechelles O, Abasse S, Rosenthal JM, Pages AS, Dorsi M, Karaoui L, ElGellab A, Le Bail Dantec F, Yangui MA, Norbert K, Kugbe Y, Lorrain S, Pignolet A, Garnier EM, Lapillonne A, Mitanchez D, Jacqz-Aigrain E, Gouyon JB. Characteristics of prescription in 29 Level 3 Neonatal Wards over a 2-year period (2017-2018). An inventory for future research. PLoS One 2019; 14:e0222667. [PMID: 31536560 PMCID: PMC6752821 DOI: 10.1371/journal.pone.0222667] [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: 04/19/2019] [Accepted: 09/03/2019] [Indexed: 12/11/2022] Open
Abstract
Objectives The primary objective of this study is to determine the current level of patient medication exposure in Level 3 Neonatal Wards (L3NW). The secondary objective is to evaluate in the first month of life the rate of medication prescription not cited in the Summary of Product Characteristics (SmPC). A database containing all the medication prescriptions is collected as part of a prescription benchmarking program in the L3NW. Material and methods The research is a two-year observational cohort study (2017–2018) with retrospective analysis of medications prescribed in 29 French L3NW. Seventeen L3NW are present since the beginning of the study and 12 have been progressively included. All neonatal units used the same computerized system of prescription, and all prescription data were completely de-identified within each hospital before being stored in a common data warehouse. Results The study population includes 27,382 newborns. Two hundred and sixty-one different medications (International Nonproprietary Names, INN) were prescribed. Twelve INN (including paracetamol) were prescribed for at least 10% of patients, 55 for less than 10% but at least 1% and 194 to less than 1%. The lowest gestational ages (GA) were exposed to the greatest number of medications (18.0 below 28 weeks of gestation (WG) to 4.1 above 36 WG) (p<0.0001). In addition, 69.2% of the 351 different combinations of an medication INN and a route of administration have no indication for the first month of life according to the French SmPC. Ninety-five percent of premature infants with GA less than 32 weeks received at least one medication not cited in SmPC. Conclusion Neonates remain therapeutic orphans. The consequences of polypharmacy in L3NW should be quickly assessed, especially in the most immature infants.
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Affiliation(s)
- Béatrice Gouyon
- Centre d’Etudes Périnatales de l’Océan Indien (EA 7388), Centre Hospitalier Universitaire de La Réunion – Site Sud, Saint Pierre, Réunion, France
| | - Séverine Martin-Mons
- Centre d’Etudes Périnatales de l’Océan Indien (EA 7388), Centre Hospitalier Universitaire de La Réunion – Site Sud, Saint Pierre, Réunion, France
| | - Silvia Iacobelli
- Centre d’Etudes Périnatales de l’Océan Indien (EA 7388), Centre Hospitalier Universitaire de La Réunion – Site Sud, Saint Pierre, Réunion, France
| | | | | | - Roselyne Brat
- Centre Hospitalier Régional d’Orléans, Orléans, France
| | | | - Yvan Couringa
- Centre Hospitalier Andrée-Rosemon, Guyane Française, France
| | | | | | - Duksha Ramful
- Centre Hospitalier Universitaire de La Réunion – Site Nord, Saint Denis, Réunion, France
| | - Francesco Bonsante
- Centre d’Etudes Périnatales de l’Océan Indien (EA 7388), Centre Hospitalier Universitaire de La Réunion – Site Sud, Saint Pierre, Réunion, France
| | | | | | | | | | - Gaël Mazeiras
- Centre Hospitalier de la Côte Basque, Bayonne, France
| | | | | | - Julien Mourdie
- Hôpital Jacques Monod – Groupe Hospitalier du Havre, Montivilliers, France
| | | | - Olivier Flechelles
- Centre Hospitalier Universitaire de Fort-de-France, Fort de France, Martinique, France
| | | | | | - Anne-Sophie Pages
- Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, France
| | - Marine Dorsi
- Centre Hospitalier Territorial Gaston-Bourret, Dumbéa, Nouvelle Calédonie, France
| | | | | | | | | | | | - Yaovi Kugbe
- Centre Hospitalier de l’Ouest Guyanais – Franck Joly, Saint Laurent du Maroni, Guyane Française, France
| | - Simon Lorrain
- Centre d’Etudes Périnatales de l’Océan Indien (EA 7388), Centre Hospitalier Universitaire de La Réunion – Site Sud, Saint Pierre, Réunion, France
| | - Anaelle Pignolet
- Centre d’Etudes Périnatales de l’Océan Indien (EA 7388), Centre Hospitalier Universitaire de La Réunion – Site Sud, Saint Pierre, Réunion, France
| | - Elodie Marie Garnier
- Centre d’Etudes Périnatales de l’Océan Indien (EA 7388), Centre Hospitalier Universitaire de La Réunion – Site Sud, Saint Pierre, Réunion, France
| | | | | | | | - Jean-Bernard Gouyon
- Centre d’Etudes Périnatales de l’Océan Indien (EA 7388), Centre Hospitalier Universitaire de La Réunion – Site Sud, Saint Pierre, Réunion, France
- * E-mail:
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Failure-to-rescue in Patients Undergoing Pancreatectomy: Is Hospital Volume a Standard for Quality Improvement Programs? Nationwide Analysis of 12,333 Patients. Ann Surg 2019; 268:799-807. [PMID: 30048329 DOI: 10.1097/sla.0000000000002945] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the influence of hospital volume on failure-to-rescue (FTR) after pancreatectomy in France. BACKGROUND There are growing evidences that FTR is an important source of postoperative mortality (POM) after pancreatectomy. However, few studies have analyzed the volume-FTR relationship following pancreatic surgery. METHODS All patients undergoing pancreatectomy between 2012 and 2015 were included. FTR is defined as the 90-day POM rate among patients with major complications. According to the spline model, the critical cutoff was 20 resections per year and hospitals were divided into low (<10 resections/an), intermediate (11-19 resections/yr), and high volume centers (≥20 resections/yr). RESULTS Overall, 12,333 patients who underwent pancreatectomy were identified. The POM was 6.9% and decreased significantly with increased hospital volume. The rate of FTR was 14.5% and varied significantly with hospital volume (18.3% in low hospital volume vs 11.9% in high hospital volume, P < 0.001), age (P < 0.001) and ChCl (CCl0-2: 11.5%, ChCl3: 13%, CCl ≥4:18.6%; P < 0.001). FTR for renal failure was the highest of all complications (40.2%), followed by postoperative shock (36.4%) and cardiac complications (35.1%). The FTR was significantly higher in low and intermediate compared with high volume hospitals for shock, digestive, and thromboembolic complications and reoperation. In multivariable analysis, intermediate (OR = 1.265, CI95%[1.103-1.701], P = 0.045) and low volume centers (OR = 1.536, CI95%[1.165-2.025], P = 0.002) were independently associated with increased FTR rates. CONCLUSION FTR after pancreatectomy is high and directly correlated to hospital volume, highlighting variability in the management of postoperative complications. Measurement of the FTR rate should become a standard for quality improvement programs.
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The French Pregnancy Cohort: Medication use during pregnancy in the French population. PLoS One 2019; 14:e0219095. [PMID: 31314794 PMCID: PMC6636733 DOI: 10.1371/journal.pone.0219095] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/14/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose We described the medication use during pregnancy in the French population using the French Pregnancy Cohort (FPC). Methods The FPC was built with the sampling of all pregnant women included in the French Echantillon généraliste des bénéficiaires (EGB), which is a 1/97th representative sample of the population covered by the French health insurance. The EGB includes anonymized information on the socio-demographic and medical characteristics of beneficiaries, and the health care services they have received such as diagnoses and procedure codes as well as data on filled reimbursed medication; EGB also includes data on hospital stays in all public and private French health facilities. Each filled prescription record contains information on drug brand and generic names, date of prescription and date of dispensing, quantity dispensed, mode of administration, duration of prescription, dosage, and prescribing physician specialty. FPC includes data on all pregnancies of women in the EGB (2010–2013). Date of entry in the FPC is the first day of pregnancy regardless of pregnancy outcome (spontaneous abortions or planned abortions (with or without medical reasons), deliveries), and data on women are collected retrospectively for a period of one year before pregnancy, and prospectively during pregnancy, and up to one year after delivery. The prevalence of prescribed medications before, during and after pregnancy was compared; comparison was also done between trimesters. Pregnancy outcomes are described and include spontaneous and planned abortions, livebirths, and stillbirths. Results FPC includes data on 36,065 pregnancies. Among them, 27,253 (75.6%) resulted in a delivery including 201 stillbirths (0.7%). The total number of spontaneous abortions was 6,718 (18.6%), and planned abortions 2,094 (5.8%). The prevalence of filled medication use was 91.1%, 89.9%, and 95.6% before, during and after pregnancy, respectively. Although there was a statistically significant decrease in the proportion of use once the pregnancy was diagnosed (first trimester exposure, 76.4% vs. exposure in the year prior to pregnancy, 91.1% (p < .01)), post-pregnancy medication use was above the pre-pregnancy level (95.6%). Maternal depression was the most prevalent comorbidity during pregnancy (20%), and post-partum depression was higher in those who delivered a stillborn infant (38.8%) as well as in those with a spontaneous (19.5%) or planned abortion (22.4%) compared to those with a liveborn (12.0%). Conclusion FPC is an excellent tool for the study of the risk and benefit of drug use during the perinatal period. FPC has the advantage of including a representative sample of French pregnant women, and study medications only available in France in addition to others available worldwide.
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Pilkington H, Prunet C, Blondel B, Charreire H, Combier E, Le Vaillant M, Amat-Roze JM, Zeitlin J. Travel Time to Hospital for Childbirth: Comparing Calculated Versus Reported Travel Times in France. Matern Child Health J 2018; 22:101-110. [PMID: 28780684 DOI: 10.1007/s10995-017-2359-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives Timely access to health care is critical in obstetrics. Yet obtaining reliable estimates of travel times to hospital for childbirth poses methodological challenges. We compared two measures of travel time, self-reported and calculated, to assess concordance and to identify determinants of long travel time to hospital for childbirth. Methods Data came from the 2010 French National Perinatal Survey, a national representative sample of births (N = 14 681). We compared both travel time measures by maternal, maternity unit and geographic characteristics in rural, peri-urban and urban areas. Logistic regression models were used to study factors associated with reported and calculated times ≥30 min. Cohen's kappa coefficients were also calculated to estimate the agreement between reported and calculated times according to women's characteristics. Results In urban areas, the proportion of women with travel times ≥30 min was higher when reported rather than calculated times were used (11.0 vs. 3.6%). Longer reported times were associated with non-French nationality [adjusted odds ratio (aOR) 1.3 (95% CI 1.0-1.7)] and inadequate prenatal care [aOR 1.5 (95% CI 1.2-2.0)], but not for calculated times. Concordance between the two measures was higher in peri-urban and rural areas (52.4 vs. 52.3% for rural areas). Delivery in a specialised level 2 or 3 maternity unit was a principal determinant of long reported and measured times in peri-urban and rural areas. Conclusions for Practice The level of agreement between reported and calculated times varies according to geographic context. Poor measurement of travel time in urban areas may mask problems in accessibility.
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Affiliation(s)
- Hugo Pilkington
- Département de Géographie, Université Paris 8 Vincennes-Saint-Denis, UMR7533 Ladyss, 2 rue de la Liberté, 93526, Saint-Denis, France.
| | - Caroline Prunet
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | - Béatrice Blondel
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | - Hélène Charreire
- Université Paris-Est, LabUrba, Ecole d'urbanisme de Paris, Créteil, France
| | - Evelyne Combier
- Centre d'épidémiologie des populations (CEP), University of Burgundy, EA4184 CHU, Hôpital du Bocage, Dijon, France
| | - Marc Le Vaillant
- Centre de Recherche, médecine, sciences, santé, santé mentale, société (CERMES3) INSERM U988 - CNRS UMR 8211, Villejuif Cedex, France
| | | | - Jennifer Zeitlin
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
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