PDF(Pubmed)
Abstract：
BACKGROUND: There is convincing evidence that birth in hospitals with high birth volumes increases the chance of healthy survival in high-risk infants. However, it is unclear whether this is true also for low risk infants. The aim of this systematic review was to analyze effects of hospital\'s birth volume on mortality, mode of delivery, readmissions, complications and subsequent developmental delays in all births or predefined low risk birth cohorts. The search strategy included EMBASE and Medline supplemented by citing and cited literature of included studies and expert panel highlighting additional literature, published between January/2000 and February/2020. We included studies which were published in English or German language reporting effects of birth volumes on mortality in term or all births in countries with neonatal mortality < 5/1000. We undertook a double-independent title-abstract- and full-text screening and extraction of study characteristics, critical appraisal and outcomes in a qualitative evidence synthesis.
RESULTS: 13 retrospective studies with mostly acceptable quality were included. Heterogeneous volume-thresholds, risk adjustments, outcomes and populations hindered a meta-analysis. Qualitatively, four of six studies reported significantly higher perinatal mortality in lower birth volume hospitals. Volume-outcome effects on neonatal mortality (n = 7), stillbirths (n = 3), maternal mortality (n = 1), caesarean sections (n = 2), maternal (n = 1) and neonatal complications (n = 1) were inconclusive.
CONCLUSIONS: Analyzed studies indicate higher rates of perinatal mortality for low risk birth in hospitals with low birth volumes. Due to heterogeneity of studies, data synthesis was complicated and a meta-analysis was not possible. Therefore international core outcome sets should be defined and implemented in perinatal registries.
UNASSIGNED: PROSPERO: CRD42018095289.
RESULTS: 13 retrospective studies with mostly acceptable quality were included. Heterogeneous volume-thresholds, risk adjustments, outcomes and populations hindered a meta-analysis. Qualitatively, four of six studies reported significantly higher perinatal mortality in lower birth volume hospitals. Volume-outcome effects on neonatal mortality (n = 7), stillbirths (n = 3), maternal mortality (n = 1), caesarean sections (n = 2), maternal (n = 1) and neonatal complications (n = 1) were inconclusive.
CONCLUSIONS: Analyzed studies indicate higher rates of perinatal mortality for low risk birth in hospitals with low birth volumes. Due to heterogeneity of studies, data synthesis was complicated and a meta-analysis was not possible. Therefore international core outcome sets should be defined and implemented in perinatal registries.
UNASSIGNED: PROSPERO: CRD42018095289.
摘要：
背景：有令人信服的证据表明，在高出生量的医院分娩会增加高危婴儿健康生存的机会。然而,目前尚不清楚这是否也适用于低风险婴儿。本系统评价的目的是分析医院的出生量对死亡率的影响，交货方式,再入院,所有分娩或预定义的低风险出生队列的并发症和随后的发育迟缓。搜索策略包括EMBASE和Medline，并通过引用和引用纳入研究的文献以及专家小组强调其他文献进行补充。在2000年1月至2020年2月之间发布。我们纳入了以英语或德语发表的研究，这些研究报告了新生儿死亡率<5/1000的国家的出生量对足月死亡率或所有出生死亡率的影响。我们进行了双重独立的标题摘要和全文筛选和提取研究特征，定性证据综合中的批判性评估和结果。
结果：纳入13项质量基本可接受的回顾性研究。异构卷阈值，风险调整，结果和人群阻碍了荟萃分析。定性,6项研究中有4项报告低出生量医院的围产期死亡率明显较高.体积结局对新生儿死亡率的影响（n=7），死胎(n=3)，孕产妇死亡率（n=1），剖腹产（n=2），产妇(n=1)和新生儿并发症(n=1)无定论.
结论：分析研究表明，在低出生率的医院中，低风险分娩的围产期死亡率较高。由于研究的异质性，数据合成很复杂,无法进行荟萃分析.因此，应在围产期登记册中定义和实施国际核心结果集。
■PROSPERO：CRD42018095289。
结果：纳入13项质量基本可接受的回顾性研究。异构卷阈值，风险调整，结果和人群阻碍了荟萃分析。定性,6项研究中有4项报告低出生量医院的围产期死亡率明显较高.体积结局对新生儿死亡率的影响（n=7），死胎(n=3)，孕产妇死亡率（n=1），剖腹产（n=2），产妇(n=1)和新生儿并发症(n=1)无定论.
结论：分析研究表明，在低出生率的医院中，低风险分娩的围产期死亡率较高。由于研究的异质性，数据合成很复杂,无法进行荟萃分析.因此，应在围产期登记册中定义和实施国际核心结果集。
■PROSPERO：CRD42018095289。
