Hospital-acquired conditions and length of stay in the pregnancy and puerperal cycle.

OBJECTIVE: To analyze the impact of the Hospital-Acquired Conditions (HAC) in women in the puerperal and pregnancy cycle during length of stay. METHODS: This cross-sectional study was conducted with 113,456 women, between July 2012 and July 2017, in Brazil's national hospitals of the supplementary healthcare networks and philanthropists accredited to the Unified Health System (SUS). Data on hospital discharges were collected using the Diagnosis-Related Groups (DRG Brasil®) system. All DRGs of the major diagnostic category 14 (MDC14), including pregnancy, childbirth and puerperium, were included. The impact of HAC on length of stay was estimated by Student's t-test, and the effect size by Cohen's d, which allows to assess clinical relevance. RESULTS: The most prevalent diagnostic categories related to MDC14 were vaginal and cesarean deliveries without complicating diagnoses, both at institutions accredited to SUS and those for supplementary health care. The prevalence of HAC was 3.8% in supplementary health and 2.5% in SUS. Hospitals providing services to supplementary health care providers had a longer length of stay considering HAC for patients classified as DRG: cesarean section with complications or comorbidities at admission (p < 0.001; Cohen's d = 0.74), cesarean section without complications or comorbidities at admission (p < 0.001, Cohen's d = 0.31), postpartum and post abortion without listed procedure (p < 0.001, Cohen's d = 1.05), and other antepartum diagnoses with medical complications (p < 0.001; Cohen's d = 0.77). CONCLUSIONS: This study showed that the prevalence of HAC was low both in the institutions accredited to attend by SUS and in those of supplementary health; however, its presence contributes to increasing the length of stay in cases of cesarean sections without complications or comorbidities in supplementary health institutions.

Hospital-acquired conditions and length of stay in the pregnancy and puerperal cycle / Condições hospitalares adquiridas e tempo de permanência no ciclo gravídico-puerperal

ABSTRACT OBJECTIVE To analyze the impact of the Hospital-Acquired Conditions (HAC) in women in the puerperal and pregnancy cycle during length of stay. METHODS This cross-sectional study was conducted with 113,456 women, between July 2012 and July 2017, in Brazil's national hospitals of the supplementary healthcare networks and philanthropists accredited to the Unified Health System (SUS). Data on hospital discharges were collected using the Diagnosis-Related Groups (DRG Brasil®) system. All DRGs of the major diagnostic category 14 (MDC14), including pregnancy, childbirth and puerperium, were included. The impact of HAC on length of stay was estimated by Student's t-test, and the effect size by Cohen's d, which allows to assess clinical relevance. RESULTS The most prevalent diagnostic categories related to MDC14 were vaginal and cesarean deliveries without complicating diagnoses, both at institutions accredited to SUS and those for supplementary health care. The prevalence of HAC was 3.8% in supplementary health and 2.5% in SUS. Hospitals providing services to supplementary health care providers had a longer length of stay considering HAC for patients classified as DRG: cesarean section with complications or comorbidities at admission (p < 0.001; Cohen's d = 0.74), cesarean section without complications or comorbidities at admission (p < 0.001, Cohen's d = 0.31), postpartum and post abortion without listed procedure (p < 0.001, Cohen's d = 1.05), and other antepartum diagnoses with medical complications (p < 0.001; Cohen's d = 0.77). CONCLUSIONS This study showed that the prevalence of HAC was low both in the institutions accredited to attend by SUS and in those of supplementary health; however, its presence contributes to increasing the length of stay in cases of cesarean sections without complications or comorbidities in supplementary health institutions.

RESUMO OBJETIVO Analisar o impacto das condições hospitalares adquiridas em mulheres no ciclo gravídico puerperal no tempo de permanência. MÉTODOS Este estudo transversal foi conduzido com 113.456 mulheres, entre julho de 2012 e julho de 2017, em hospitais nacionais da rede suplementar de saúde e filantrópicos credenciados para atendimento pelo Sistema Único de Saúde (SUS). Os dados das altas hospitalares foram coletados utilizando o sistema Diagnosis-Related Groups (DRG Brasil®). Foram incluídos todos os DRG que compõem a grande categoria diagnóstica 14 (MDC14), abrangendo gestação, parto e puerpério. O impacto das condições hospitalares adquiridas no tempo de permanência foi estimado por meio do teste t de Student, e o tamanho do efeito pelo d de Cohen, que permite avaliar a relevância clínica. RESULTADOS As categorias diagnósticas relacionadas à MDC14 mais prevalentes foram partos vaginais sem diagnósticos complicadores e cesáreas, tanto nas instituições credenciadas para atendimento pelo SUS quanto nas de saúde suplementar. A prevalência de condições hospitalares adquiridas foi de 3,8% na saúde suplementar e 2,5% no SUS. Observou-se maior tempo de permanência nos hospitais que prestam serviços a operadoras da saúde suplementar do Brasil na presença de CHA para as pacientes categorizadas nos DRG: cesariana com complicações ou comorbidades presentes à admissão (p < 0,001; d de Cohen = 0,74), cesariana sem complicações ou comorbidades presentes à admissão (p < 0,001; d de Cohen = 0,31), doenças puerperais e pós-aborto sem cirurgia (p < 0,001; d de Cohen = 1,05) e outras doenças da gravidez com complicações clínicas (p < 0,001; d de Cohen = 0,77). CONCLUSÕES O presente estudo revelou que a prevalência de condições adquiridas foi baixa tanto nas instituições credenciadas para atendimento pelo SUS quanto nas de saúde suplementar; entretanto, sua presença contribui para o aumento do tempo de permanência hospitalar em casos de cesáreas sem complicações ou comorbidades nas instituições de saúde suplementar.