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Abstract：
BACKGROUND: Incidence of complications following obstetrical anal sphincter injury (OASI) during vaginal delivery are poorly defined. They are only studied in high level maternities, small cohorts, all stages of perineal tear or in low-income countries. The aim of our study was to describe complications after primary OASI repair following a vaginal delivery in all French maternity wards at short and midterm and to assess factors associated with complication occurrence.
METHODS: We conducted a historical cohort study using the French nationwide claim database (PMSI) from January 2013 to December 2021. All women who sustained an OASI repair following a vaginal delivery were included and virtually followed-up for 2 years. Then, we searched for OASIS complications. Finally, we evaluated factors associated with OASIS complication repaired or not and OASIS complication repairs.
RESULTS: Among the 61,833 included women, 2015 (2.8%) had an OASI complication and 842 (1.16%) underwent an OASI complication repair. Women were mainly primiparous (71.6%) and 44.3% underwent an instrumental delivery. During a follow-up of 2 years, 0.6% (n = 463), 0.3% (n = 240), 0.2% (n = 176), 0.1% (n = 84), 0.06% (n = 43) and 0.01% (n = 5) of patients underwent second surgery for a perineal repair, a fistula repair, a sphincteroplasty, a perineal infection, a colostomy and a sacral nervous anal stimulation, respectively. Only one case of artificial anal sphincter was noticed. Instrumental deliveries (OR = 1.56 CI95%[1.29;1.9]), private for-profit hospitals (OR = 1.42 [1.11;1.82], reference group \"public hospital\"), obesity (OR = 1.36 [1;1.84]), stage IV OASIS (OR = 2.98 [2.4;3.72]), perineal wound breakdown (OR = 2.8 [1.4;5.48]), ages between 25 and 29 years old (OR = 1.59 [1.17;2.18], refence group \"age between 13 and 24 years old\") and 30 and 34 years old (OR = 1.57 [1.14; 2.16], refence group \"age between 13 and 24 years old\") were factors associated with OASIS complication repairs.
CONCLUSIONS: Maternal age, stage IV OASIS, obesity, instrumental deliveries and private for-profit hospitals seemed to predict OASIS complications. Understanding factors associated with OASIS complications could be beneficial for the patient to inform them and to influence the patient\'s follow-up in order to prevent complications, repairs and maternal distress.
METHODS: We conducted a historical cohort study using the French nationwide claim database (PMSI) from January 2013 to December 2021. All women who sustained an OASI repair following a vaginal delivery were included and virtually followed-up for 2 years. Then, we searched for OASIS complications. Finally, we evaluated factors associated with OASIS complication repaired or not and OASIS complication repairs.
RESULTS: Among the 61,833 included women, 2015 (2.8%) had an OASI complication and 842 (1.16%) underwent an OASI complication repair. Women were mainly primiparous (71.6%) and 44.3% underwent an instrumental delivery. During a follow-up of 2 years, 0.6% (n = 463), 0.3% (n = 240), 0.2% (n = 176), 0.1% (n = 84), 0.06% (n = 43) and 0.01% (n = 5) of patients underwent second surgery for a perineal repair, a fistula repair, a sphincteroplasty, a perineal infection, a colostomy and a sacral nervous anal stimulation, respectively. Only one case of artificial anal sphincter was noticed. Instrumental deliveries (OR = 1.56 CI95%[1.29;1.9]), private for-profit hospitals (OR = 1.42 [1.11;1.82], reference group \"public hospital\"), obesity (OR = 1.36 [1;1.84]), stage IV OASIS (OR = 2.98 [2.4;3.72]), perineal wound breakdown (OR = 2.8 [1.4;5.48]), ages between 25 and 29 years old (OR = 1.59 [1.17;2.18], refence group \"age between 13 and 24 years old\") and 30 and 34 years old (OR = 1.57 [1.14; 2.16], refence group \"age between 13 and 24 years old\") were factors associated with OASIS complication repairs.
CONCLUSIONS: Maternal age, stage IV OASIS, obesity, instrumental deliveries and private for-profit hospitals seemed to predict OASIS complications. Understanding factors associated with OASIS complications could be beneficial for the patient to inform them and to influence the patient\'s follow-up in order to prevent complications, repairs and maternal distress.
摘要：
背景：阴道分娩期间产科肛门括约肌损伤（OASI）并发症的发生率尚不明确。它们只在高水平的母系中研究，小团体，会阴撕裂的所有阶段或在低收入国家。我们研究的目的是描述短期和中期所有法国产科病房阴道分娩后初次OASI修复后的并发症，并评估与并发症发生相关的因素。
方法：我们从2013年1月至2021年12月使用法国全国索赔数据库（PMSI）进行了一项历史队列研究。包括所有在阴道分娩后进行OASI修复的妇女，并进行了2年的随访。然后，我们搜索了OASIS并发症.最后,我们评估了OASIS并发症修复与否和OASIS并发症修复的相关因素.
结果：在61,833名女性中，2015年（2.8%）发生OASI并发症，842例（1.16%）接受了OASI并发症修复。妇女主要是初产（71.6％），而44.3％的妇女接受了器械分娩。在2年的随访中，0.6%(n=463)，0.3%（n=240），0.2%（n=176），0.1%(n=84)，0.06％（n=43）和0.01％（n=5）的患者接受了会阴修复的第二次手术，瘘管修复术,括约肌成形术,会阴感染,结肠造口术和骶神经肛门刺激，分别。仅发现一例人工肛门括约肌。工具交付（OR=1.56CI95%[1.29;1.9]），私营营利性医院(OR=1.42[1.11；1.82]，参考组“公立医院”)，肥胖（OR=1.36[1;1.84]），第四阶段绿洲(OR=2.98[2.4;3.72])，会阴伤口破裂（OR=2.8[1.4;5.48]），年龄在25至29岁之间(OR=1.59[1.17;2.18]，复习组“年龄在13至24岁之间”）和30至34岁（OR=1.57[1.14;2.16]，复习组“年龄在13至24岁之间”）是与OASIS并发症修复相关的因素。
结论：产妇年龄，第四阶段绿洲，肥胖，工具性分娩和私立营利性医院似乎可以预测OASIS并发症。了解与OASIS并发症相关的因素可能有利于患者告知这些因素，并影响患者的随访，以预防并发症。修复和产妇痛苦。
方法：我们从2013年1月至2021年12月使用法国全国索赔数据库（PMSI）进行了一项历史队列研究。包括所有在阴道分娩后进行OASI修复的妇女，并进行了2年的随访。然后，我们搜索了OASIS并发症.最后,我们评估了OASIS并发症修复与否和OASIS并发症修复的相关因素.
结果：在61,833名女性中，2015年（2.8%）发生OASI并发症，842例（1.16%）接受了OASI并发症修复。妇女主要是初产（71.6％），而44.3％的妇女接受了器械分娩。在2年的随访中，0.6%(n=463)，0.3%（n=240），0.2%（n=176），0.1%(n=84)，0.06％（n=43）和0.01％（n=5）的患者接受了会阴修复的第二次手术，瘘管修复术,括约肌成形术,会阴感染,结肠造口术和骶神经肛门刺激，分别。仅发现一例人工肛门括约肌。工具交付（OR=1.56CI95%[1.29;1.9]），私营营利性医院(OR=1.42[1.11；1.82]，参考组“公立医院”)，肥胖（OR=1.36[1;1.84]），第四阶段绿洲(OR=2.98[2.4;3.72])，会阴伤口破裂（OR=2.8[1.4;5.48]），年龄在25至29岁之间(OR=1.59[1.17;2.18]，复习组“年龄在13至24岁之间”）和30至34岁（OR=1.57[1.14;2.16]，复习组“年龄在13至24岁之间”）是与OASIS并发症修复相关的因素。
结论：产妇年龄，第四阶段绿洲，肥胖，工具性分娩和私立营利性医院似乎可以预测OASIS并发症。了解与OASIS并发症相关的因素可能有利于患者告知这些因素，并影响患者的随访，以预防并发症。修复和产妇痛苦。
