PMID- 30742828
OWN - NLM
STAT- Publisher
LR  - 20190330
IS  - 1097-6868 (Electronic)
IS  - 0002-9378 (Linking)
DP  - 2019 Feb 8
TI  - Life-threatening complications among women with severe ovarian hyperstimulation
      syndrome.
LID - S0002-9378(19)30350-3 [pii]
LID - 10.1016/j.ajog.2019.02.009 [doi]
AB  - BACKGROUND: Ovarian hyperstimulation syndrome is a potentially life-threatening
      clinical condition. OBJECTIVE: The objective of this study was to evaluate risk
      factors for life-threatening complications for patients with severe ovarian
      hyperstimulation syndrome in a United States nationwide sample. MATERIALS AND
      METHODS: Ovarian hyperstimulation syndrome admissions from 2002 to 2011 from the 
      Nationwide Inpatient Sample were included in this study. The association between 
      patient and hospital factors and life-threatening complications (deep vein
      thrombosis/pulmonary embolism, acute respiratory distress syndrome, acute renal
      failure, intubation), nonroutine discharge (discharge to skilled nursing
      facility, transfer hospital), prolonged length of stay, and total hospital
      charges were analyzed. Survey-adjusted multivariable logistic regression analyses
      were performed for these outcomes, controlling for risk factors, with adjusted
      odds ratios with 95% confidence intervals as the measures of effect. RESULTS: A
      total of 11,562 patients were hospitalized with severe ovarian hyperstimulation
      syndrome from 2002 to 2011. The majority were white (55.7%), with private
      insurance (87.7%), aged 25-39 years (84.6%), and hospitalized in an urban
      location (95%). In all, 19.3% of patients had medical comorbidities including
      hypertension, diabetes, obesity, hypothyroidism, and anemia. Life-threatening
      complications occurred in 4.4% of patients (deep vein thrombosis/pulmonary
      embolism, 2.2%; acute renal failure; acute respiratory distress syndrome, 0.9%;
      intubation, 0.5%). Patients >/=40 years old (odds ratio, 4.02; 95% confidence
      interval, 1.37, 11.76), those with comorbidities (odds ratio, 2.29; 95%
      confidence interval, 1.46, 3.57), and African American patients (odds ratio,
      2.15; 95% confidence interval, 1.25, 3.70) were more likely to develop
      life-threatening conditions. Patients with medical comorbidities (odds ratio,
      0.39; 95% confidence interval, 0.24, 0.63) were also less likely to be routinely 
      discharged from the hospital. Adjusting for patient and hospital demographics,
      patients with comorbidities were more likely to develop deep vein
      thrombosis/pulmonary embolism (adjusted odds ratio, 2.44; 95% confidence
      interval, 1.28, 4.65) and acute renal failure (adjusted odds ratio, 2.26; 95%
      confidence interval, 1.21, 4.23). Patients who developed life-threatening
      complications had longer hospital length of stay (adjusted odds ratio, 3.72; 95% 
      confidence interval, 2.28, 6.07) and higher hospital costs (adjusted odds ratio, 
      5.20; 95% confidence interval, 3.22,8.39). CONCLUSION: Patients with common
      medical comorbidities are at higher risk for life-threatening complications in
      the setting of severe ovarian hyperstimulation syndrome. Furthermore, these
      complications are associated with high hospital costs and hospital burden. Given 
      the increasing number of in vitro fertilization patients with medical
      comorbidities, closer monitoring of at-risk patients may be indicated. As
      assisted reproductive technology practice changes in recent years with strategies
      designed to reduce ovarian hyperstimulation syndrome risk, future studies are
      needed to assess the impact of these changes on hospitalization and complication 
      risk.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Selter, Jessica
AU  - Selter J
AD  - Department of Obstetrics & Gynecology, Columbia University Irving Medical Center,
      New York, NY. Electronic address: js4958@cumc.columbia.edu.
FAU - Wen, Timothy
AU  - Wen T
AD  - Department of Obstetrics & Gynecology, Columbia University Irving Medical Center,
      New York, NY.
FAU - Palmerola, Katherine L
AU  - Palmerola KL
AD  - Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology
      and Infertility, Columbia University Medical Center, New York, NY.
FAU - Friedman, Alexander M
AU  - Friedman AM
AD  - Department of Obstetrics & Gynecology, Columbia University Irving Medical Center,
      New York, NY.
FAU - Williams, Zev
AU  - Williams Z
AD  - Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology
      and Infertility, Columbia University Medical Center, New York, NY.
FAU - Forman, Eric J
AU  - Forman EJ
AD  - Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology
      and Infertility, Columbia University Medical Center, New York, NY.
LA  - eng
PT  - Journal Article
DEP - 20190208
PL  - United States
TA  - Am J Obstet Gynecol
JT  - American journal of obstetrics and gynecology
JID - 0370476
OTO - NOTNLM
OT  - ovarian hyperstimulation syndrome
OT  - severe morbidity
EDAT- 2019/02/12 06:00
MHDA- 2019/02/12 06:00
CRDT- 2019/02/12 06:00
PHST- 2018/10/17 00:00 [received]
PHST- 2018/12/28 00:00 [revised]
PHST- 2019/02/03 00:00 [accepted]
PHST- 2019/02/12 06:00 [pubmed]
PHST- 2019/02/12 06:00 [medline]
PHST- 2019/02/12 06:00 [entrez]
AID - S0002-9378(19)30350-3 [pii]
AID - 10.1016/j.ajog.2019.02.009 [doi]
PST - aheadofprint
SO  - Am J Obstet Gynecol. 2019 Feb 8. pii: S0002-9378(19)30350-3. doi:
      10.1016/j.ajog.2019.02.009.