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Hospital-related factors associated with venous thromboembolism incidence in pregnancy: a national survey in China
  • Qiongjie Zhou,
  • Xiaotian Li
Qiongjie Zhou
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Xiaotian Li
Obstetrics and Gynecology Hospital of Fudan University
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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.