Abstract | BACKGROUND: METHODS: The Premier Research Database was used to define a cohort of 2,180,916 patients hospitalized for delivery at 1 of 367 hospitals from 2007 to 2011. Mixed-effects logistic regression models were used to estimate the hospital-specific frequency of second-line uterotonic use adjusting for measured patient-level and hospital-level characteristics that might be risk factors for uterine atony. RESULTS: The median hospital-level frequency of second-line uterotonic use was 7.1% (interquartile range 5.2-% to 10.8%). In the fully adjusted model, the mean (SE) predicted probability of second-line uterotonic use was 7.02% (0.26%), with 95% of the hospitals having a predicted (SE) probability between 1.69% (0.12%) and 24.96% (1.28%). CONCLUSIONS: We observed wide interhospital variation in the use of second-line uterotonics that was not explained by patient-level or hospital-level characteristics. Studies aimed at defining the optimal pharmacologic strategies for the management of uterine atony are needed, particularly in light of the increasing incidence of atonic postpartum hemorrhage in the United States and other developed countries.
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Authors | Brian T Bateman, Lawrence C Tsen, Jun Liu, Alexander J Butwick, Krista F Huybrechts |
Journal | Anesthesia and analgesia
(Anesth Analg)
Vol. 119
Issue 6
Pg. 1344-9
(Dec 2014)
ISSN: 1526-7598 [Electronic] United States |
PMID | 25166464
(Publication Type: Journal Article, Research Support, N.I.H., Extramural)
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Chemical References |
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Topics |
- Adolescent
- Adult
- Chi-Square Distribution
- Child
- Female
- Hospitalization
- Humans
- Incidence
- Logistic Models
- Middle Aged
- Oxytocics
(adverse effects, therapeutic use)
- Parturition
- Postpartum Hemorrhage
(epidemiology, prevention & control)
- Practice Patterns, Physicians'
(trends)
- Pregnancy
- Risk Factors
- Time Factors
- Treatment Outcome
- United States
(epidemiology)
- Uterine Inertia
(diagnosis, drug therapy, epidemiology)
- Young Adult
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