Estudio de validación de internaciones obstétricas en el Sistema de Información Hospitalaria del Sistema Único de Salud para vigilancia de la morbilidad materna: Brasil, 2021-2022

Domingues, Rosa Maria Soares Madeira; Meijinhos, Lana dos Santos; Guillen, Luis Carlos Torres; Dias, Marcos Augusto Bastos; Saraceni, Valéria; Pinheiro, Rejane Sobrinho; Paiva, Natália Santana; Coeli, Cláudia Medina

Rosa Maria Soares Madeira Domingues

contributed to the study concept and design

analysis and interpretation of the results

drafting and critically reviewing the contents of the manuscript

All the authors have approved the final version of the manuscript and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Fundação Oswaldo Cruz, Laboratório de Pesquisa Clínica em DST/Aids, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0001-5722-8127

Lana dos Santos Meijinhos

contributed to the study concept and design

analysis and interpretation of the results

drafting and critically reviewing the contents of the manuscript

All the authors have approved the final version of the manuscript and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0002-0223-0438

Luis Carlos Torres Guillen

contributed to data analysis and interpretation

drafting and critically reviewing the contents of the manuscript

All the authors have approved the final version of the manuscript and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0001-5246-733X

Marcos Augusto Bastos Dias

contributed to data analysis and interpretation

drafting and critically reviewing the contents of the manuscript

All the authors have approved the final version of the manuscript and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Fundação Oswaldo Cruz, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente “Fernandes Figueira”, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0003-1386-7001

Valéria Saraceni

contributed to data analysis and interpretation

drafting and critically reviewing the contents of the manuscript

All the authors have approved the final version of the manuscript and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Secretaria Municipal de Saúde do Rio de Janeiro, Superintendência de Vigilância em Saúde, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0001-7360-6490

Rejane Sobrinho Pinheiro

contributed to drafting and critically reviewing the contents of the manuscript

All the authors have approved the final version of the manuscript and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0002-3361-3626

Natália Santana Paiva

contributed to drafting and critically reviewing the contents of the manuscript

All the authors have approved the final version of the manuscript and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0003-0541-4686

Cláudia Medina Coeli

contributed to data analysis and interpretation

drafting and critically reviewing the contents of the manuscript

All the authors have approved the final version of the manuscript and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0003-1757-3940

Correspondence: Rosa Maria Soares Madeira Domingues | rosa.domingues@ini.fiocruz.br

CONFLICTS OF INTEREST

The authors have no conflicts of interest to declare.

Associate editor:

Doroteia Aparecida Höfelmann

Criterion	ICD ^a		Procedures ^b
Obstetric hospitalization	ICD group “O” recorded in one of the following fields: primary diagnosis, secondary diagnosis, secondary diagnoses 1 to 9, ICD associated, ICD notification, ICD death	OR	02.01.01.001-1, 02.11.04.001-0, 02.11.04.006-1, 03.10.01.001-2, 03.10.01.002-0, 03.10.01.003-9, 03.10.01.004-7, 03.10.01.005-5, 03.03.10.001-0, 03.03.10.002-8, 03.03.10.003-6, 03.03.10.004-4, 03.03.10.005-2, 04.09.06.001-1, 04.09.06.005-4, 04.09.06.007-0, 04.11.01.001-8, 04.11.01.002-6, 04.11.01.003-4, 04.11.01.004-2, 04.11.01.005-0, 04.11.01.007-7, 04.11.01.008-5, 04.11.02.001-3, 04.11.02.002-1, 04.11.02.003-0, 04.11.02.004-8, 04.17.01.002-8, 04.17.01.001-0, 04.17.01.003-6
Reason for hospitalization
Pregnancy with abortive outcome	Primary ICD O00 to O08
Delivery	Primary ICD 032 to 036, O60 to O69, O75, O80 to O84, P95	OR	03.10.01.001-2, 03.10.01.003-9, 03.10.01.004-7, 03.10.01.005-5, 04.11.01.002-6, 04.11.01.003-4, 04.11.01.004-2
Complications during pregnancy	Primary ICD O10 to O28, O30, O31, O40-O48 or any ICD from another group, as long as the procedure is not 03.10.01.001-2, 03.10.01.003-9, 03.10.01.004-7, 03.10.01.005-5, 04.11.01.002-6, 04.11.01.003-4, 04.11.01.004-2	OR	03.03.10.004-4
Complications related to the puerperium	Primary ICD O70, O71, O72, O73, O85 to O94		03.03.10.001-0
Discharge type
Routine discharge	Billing reason = 1, 6.1, 6.2, 6.3, 6.4
Administrative	Billing reason = 5
Continuing inpatient stay	Billing reason = 2
Death	Billing reason = 4, 6.5, 6.6, 6.7
Transfer	Billing reason = 3
Left blank	Billing reason not filled in
Specific diagnoses and procedures
Severe pre-eclampsia	O141
Eclampsia	O150, O151, O152, O159	OR	03.03.10.002-8
HELLP^c syndrome	O142
A bruptio placentae	O450, O458, O459
Postpartum or postabortion hemorrhage	O720, O721, O722, O723, O031, O036, O041, O046, O051, O056, O061, O066, O071, O076, O081
Rupture of uterus	O710 and O711
Ectopic pregnancy	O000, O001, O002, O008, O009	OR	04.11.02.004-8
Hysterectomy	O822	OR	04.11.02.003-0, 04.09.06.010-0, 04.09.06.011-9, 04.09.06.012-7, 04.09.06.013-5
Laparotomy			04.07.04.016-1
Blood product transfusion	Z513	OR	03.06.02.006-8, 03.06.02.007-6, 03.06.02.008-4, 03.06.02.009-2, 03.06.02.010-6, 03.06.02.011-4, 03.06.02.012-2, 03.06.02.013-0, 03.06.02.014-9
Hospitalization in ICU^d			UTI_MES_TO^e variable > 0 or procedures 08.02.01.010-5, 08.02.01.008-3, 08.02.01.009-1, 08.02.01.029-6, 08.02.01.031-8

Reason for hospitalization	Public units		Private units		Total
Reason for hospitalization	MMG ^a (n = 18,688) ^c (%)	SIH/SUS ^b (n = 18,911) (%)	MMG ^a (n = 8,615) ^c (%)	SIH/SUS ^b (n = 7,177) (%)	MMG ^a (n = 27,303) ^c (%)	SIH/SUS ^b (n = 26,088) (%)
Delivery	72.2	78.7	73.0	81.2	72.5	79.4
Abortion	9.2	8.7	7.7	7.3	8.8	8.3
Complications during pregnancy	16.1	9.9	17.4	9.1	16.5	9.7
Complications during puerperium	2.3	2.5	1.8	1.7	2.1	2.3
Other^d	–	0.2	–	0.7	–	0.4
Left blank^e	0.1	–	0.1	–	0.1	–
Discharge type	Public units		Private units		Total
Discharge type	MMG ^a (n = 22,125) (%)	SIH/SUS ^b (n = 22,176) (%)	MMG ^a (n = 11,742) (%)	SIH/SUS ^b (n = 10,036) (%)	MMG ^a (n =33,867) (%)	SIH/SUS ^b (n = 32,212) (%)
Routine discharge	96.7	97.0	98.1	99.0	97.2	97.6
Administrative	1.4	0.6	1.0	–	1.3	0.5
Continuing inpatient stay^f	–	0.9	–	0.3	–	0.7
Death	–	0.1	0.1	0.1	0.1	0.1
Transfer	1.9	1.4	0.7	0.5	1.5	1.1

Specific diagnoses and procedures	Data source					Sens. ^g (%)	Spec. ^h (%)	LR neg ⁱ	LR pos ^j
	MMG ^a n (%)	SIH/SUS ^b
	MMG ^a n (%)	ICD ^c n (%)	PROC_REA ^d n (%)	ATO PROF ^e n (%)	TOTAL ^f n (%)
Diagnoses
Severe pre-eclampsia
Public hospital	639 (18.3)	317 (9.1)	–	–	317 (9.1)	39.3	97.7	0.62	17.0
Private hospital	184 (15.9)	97 (8.4)	–	–	97 (8.4)	33.7	96.4	0.69	9.4
Total	823 (17.7)	414 (8.9)			414 (8.9)	38.0	97.4	0.64	14.4
Eclampsia
Public hospital	94 (2.7)	71 (2.0)	4 (0.1)	4 (0.1)	71 (2.0)	20.2	98.5	0.81	13.2
Private hospital	32 (2.8)	15 (1.3)	–	–	15 (1.3)	31.3	99.6	0.69	70.3
Total	126 (2.7)	86 (1.8)	4 (0.1)	4 (0.1)	86 (1.8)	23.0	98.7	0.78	18.3
HELLP ^k syndrome
Public hospital	105 (3.0)	–	–	–	–		100.0	1.0	–
Private hospital	40 (3.5)	–	–	–	–		100.0	1.0	–
Total	145 (3.1)	–			–	–	100.0	1.0	–
Abruptio placentae
Public hospital	129 (3.7)	59 (1.7)	–	–	59 (1.7)	42.6	99.9	0.57	358.9
Private hospital	47 (4.1)	16 (1.4)	–	–	16 (1.4)	25.5	99.6	0.75	70.8
Total	176 (3.8)	75 (1.6)			75 (1.6)	38.1	99.8	0.62	213.0
Hemorrhages
Public hospital	466 (13.3)	53 (1.5)	–	–	53 (1.5)	5.2	99.0	0.96	5.4
Private hospital	175 (15.1)	22 (1.9)	–	–	22 (1.9)	2.9	98.3	0.99	1.7
Total	641 (13.8)	75 (1.6)			75 (1.6)	4.5	98.9	0.97	3.9
Rupture of uterus
Public hospital	23 (0.7)	2 (0.1)	–	–	2 (0.1)	4.3	100.0	0.96	151.0
Private hospital	1 (0.1)	1 (0.1)	–	–	1 (0.1)	–	99.9	1.0	–
Total	24 (0.5)	3 (0.1)			3 (0.1)	4.2	100.0	0.96	96.4
Ectopic pregnancy
Public hospital	169 (4.8)	157 (4.5)	121 (3.5)	121 (3.5)	159 (4.5)	93.5	100.0	0.07	3,110.5
Private hospital	41 (3.5)	33 (2.9)	30 (2.6)	31 (2.7)	37 (3.2)	90.2	100.0	0.10	–
Total	210 (4.5)	190 (4.1)	151 (3.2)	152 (3.3)	196 (4.2)	92.2	100.0	0.07	4,124.7
Specific procedures
Hysterectomy
Public hospital	40 (1.1)	1 (0.0)	9 (0.3)	8 (0.2)	15 (0.4)	37.5	100.0	0.62	–
Private hospital	23 (2.0)	–	4 (0.3)	6 (0.5)	8 (0.7)	34.8	100.0	0.65	–
Total	63 (1.4)	1 (0.0)	13 (0.3)	14 (0.3)	23 (0.5)	36.5	100.0	0.63	–
Laparotomy
Public hospital	168 (4.8)	–	28 (0.8)	28 (0.8)	28 (0.8)	16.1	100.0	0.84	534.9
Private hospital	44 (3.8)	–	6 (0.5)	6 (0.5)	6 (0.5)	11.4	99.9	0.89	126.4
Total	212 (4.6)		34 (0.7)	34 (0.7)	34 (0.7)	15.1	100.0	0.85	335.1
Blood product transfusion
Public hospital	187 (5.3)	–	–	162 (4.6)	162 (4.6)	46.0	97.7	0.55	20.0
Private hospital	73 (6.3)	–	–	80 (6.9)	80 (6.9)	61.6	96.8		19.1
Total	260 (5.6)	–	–	242 (5.2)	242 (5.2)	50.4	97.5	0.51	22.4
Hospitalization in ICU ^l
Public hospital	243 (7.0)	168 (4.8)^m	–	158 (4.5)	168 (4.8)	65.0	99.7	0.35	211.5
Private hospital	86 (7.4)	80 (6.9)^m	–	71 (6.1)	80 (6.9)	86.0	99.4	0.14	153.5
Total	329 (7.1)	248 (5.3)^m	–	229 (4.9)	248 (5.3)	70.5	99.6	0.30	190.5

[1] Correspondence: Rosa Maria Soares Madeira Domingues | rosa.domingues@ini.fiocruz.br

Brasil

Brasil

Estudio de validación de internaciones obstétricas en el Sistema de Información Hospitalaria del Sistema Único de Salud para vigilancia de la morbilidad materna: Brasil, 2021-2022

RESUMEN

Objetivo

Métodos

Resultados

Conclusión