Hospital-related factors associated with venous thromboembolism
incidence in pregnancy: a national survey in China
Abstract
Objective: We aimed to investigate the venous thromboembolism (VTE)
status in China, and identify the hospital organizational factors that
affect VTE incidence. Design: Retrospective study. Setting: Online
survey to evaluate hospital-related factors associated with VTE.
Population or sample: Hospital-related general data, and those on system
and strategy, diagnosis and treatment, and patient education were
collected. Methods: T-tests and analyses of variance were performed to
determine whether hospital-related factors were associated with VTE
incidence. Main outcome measures: VTE incidence. Results: Totally, 113
hospitals were included. Of 770,828 deliveries, VTE was observed in 526:
423 cases with deep vein thrombosis (DVT), 103 with pulmonary embolism
(PE), and three with maternal death due to VTE. Higher prevalence rates
of DVT and PE were observed in tertiary hospitals (P<0.001),
general hospitals (P=0.006), hospitals with a Cesarean section
performance rate >50% or <30%
(P<0.001). Women in hospitals with a higher Cesarean section
performance rate (relative risk [RR]=1.6), and that did not have
emergency transfer facilities (RR=10.6) or early mobilization
implementation (RR=1.6) showed a significantly higher risk of DVT. Those
in hospitals that did not use B ultrasound of the lower extremity vein
(RR=1.4) and anticoagulants (RR=1.2), and did not implement early
mobilization after vaginal (RR=1.3) and Cesarean section delivery
(RR=1.1) had an increased PE risk. Conclusions: Large hospital-related
variations were shown in the incidence of thromboembolism in pregnancy,
significantly influenced by hospital-related characteristics and
diagnostic competency. Improved patient education levels and VTE
treatment availability are vital to reducing the VTE-related maternal
mortality and morbidity risk.