Hysterectomy for postpartum hemorrhage in Japan: Diagnostic code validation and nationwide descriptive analysis

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of Obstetrics and Gynaecology Research Pub Date : 2025-07-28 DOI:10.1111/jog.70019

Eishin Nakamura, Tadahiro Goto, Shigetaka Matsunaga, Akihiko Kikuchi, Yasushi Takai, Sayuri Shimizu

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引用次数: 0

Abstract

Aim

Hysterectomy is a life-saving procedure for severe postpartum hemorrhage (PPH), but reports on postoperative mortality are limited. This study aimed to describe the rates of hysterectomy and associated mortality in PPH patients using the Diagnosis Procedure Combination (DPC) database, Japan's largest inpatient database.

Method

We first validated the accuracy of PPH diagnostic coding at a tertiary perinatal center, then conducted a nationwide descriptive analysis using DPC data from April 2018 to March 2023. The DPC database includes over half of all acute care hospital admissions in Japan. PPH cases were identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes and blood loss data. We examined hysterectomy rates and postoperative mortality, including a subgroup excluding cases with conditions requiring planned hysterectomy during cesarean section (e.g., placenta previa, accreta, uterine rupture, and cervical cancer).

Results

The validation study showed high accuracy of PPH coding, with a sensitivity of 97.8% and specificity of 99.7%. Among 209 555 PPH cases, 1835 (0.88%) underwent hysterectomy, with a mortality rate of 0.87% (16 deaths). After excluding 23 039 cases with indications for planned hysterectomy, 681 of 186 516 cases (0.36%) required hysterectomy, with a higher mortality rate of 2.2%.

Conclusions

The DPC database reliably identifies PPH cases. Hysterectomy was performed in 0.88% of all PPH cases, with higher mortality in emergency cases after excluding planned procedures.

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日本产后出血子宫切除术：诊断代码验证和全国描述性分析

目的子宫切除术是一种挽救生命的手术治疗严重产后出血（PPH），但有关术后死亡率的报道有限。本研究旨在利用日本最大的住院患者数据库诊断程序组合（DPC）数据库描述PPH患者子宫切除术和相关死亡率。方法首先对某三级围产中心PPH诊断编码的准确性进行验证，然后利用2018年4月至2023年3月的全国DPC数据进行描述性分析。DPC数据库包括日本一半以上的急症住院病例。PPH病例采用《国际疾病与相关健康问题统计分类》第10版代码和失血数据进行鉴定。我们检查了子宫切除术率和术后死亡率，包括一个排除剖宫产术中需要计划子宫切除术的病例的亚组（如前置胎盘、增生、子宫破裂和宫颈癌）。结果验证研究显示PPH编码具有较高的准确性，敏感性为97.8%，特异性为99.7%。209 555例PPH患者中，1835例（0.88%）行子宫切除术，死亡率为0.87%（死亡16例）。排除有计划子宫切除术指征的23 039例后，186 516例中有681例（0.36%）需要子宫切除术，死亡率为2.2%。结论DPC数据库可可靠地识别PPH病例。子宫切除术占所有PPH病例的0.88%，排除计划手术后急诊病例的死亡率更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Obstetrics and Gynaecology Research 医学-妇产科学

CiteScore

3.10

自引率

0.00%

发文量

376

审稿时长

3-6 weeks

期刊介绍： The Journal of Obstetrics and Gynaecology Research is the official Journal of the Asia and Oceania Federation of Obstetrics and Gynecology and of the Japan Society of Obstetrics and Gynecology, and aims to provide a medium for the publication of articles in the fields of obstetrics and gynecology. The Journal publishes original research articles, case reports, review articles and letters to the editor. The Journal will give publication priority to original research articles over case reports. Accepted papers become the exclusive licence of the Journal. Manuscripts are peer reviewed by at least two referees and/or Associate Editors expert in the field of the submitted paper.