Fernando Lopes

Objective: Episiotomy and obstetric anal sphincter injuries (OASIS) are recognized indicators of intrapartum care quality. The aim of this study was to assess episiotomy trends in non‐instrumental vaginal deliveries across all Portuguese public maternities over the last decade. Rates of third‐ and fourth‐degree perineal lacerations were also evaluated. Methods: A retrospective secondary data analysis was conducted using data from an official national health entity, including all non‐instrumental vaginal deliveries in the Portuguese National Health Service between January 1, 2013 and December 31, 2022. Information on episiotomy and third‐ and fourth‐degree perineal lacerations was extracted. Descriptive statistics were presented using absolute and relative frequencies. Linear regression was used to assess trends. Additional national databases were consulted to validate findings, and data quality was assessed using the intraclass correlation coefficient (ICC). A significance level of 5% was considered. Results: Of 689 908 registered deliveries, 490 322 (71%) were vaginal, and 361 887 (52%) were non‐instrumental vaginal deliveries. Among the latter, the episiotomy rate was 42.5%. A significant decrease was observed in episiotomy rates, from 63% in 2013 to 21% in 2022, ( P < 0.001), accompanied by a significant increase in third‐degree perineal lacerations (0.15% to 0.31%, P < 0.001), while fourth‐degree perineal lacerations remained stable (0.03% to 0.02%, P = 0.001). Conclusion: A restrictive episiotomy policy was increasingly adopted in Portugal over the last decade. Although rare, third‐degree perineal lacerations increased during this period. Further research is needed to determine optimal intrapartum care practices regarding episiotomy use. Standardized data coding and improved access to anonymized national datasets are essential for accurate monitoring and cross‐country comparability.

Background: Health records are the basis of clinical coding. In Portugal, relevant diagnoses and procedures are abstracted and categorised using an internationally accepted classification system and the resulting codes, together with the administrative data, are then grouped into diagnosis-related groups (DRGs). Hospital reimbursement is partially calculated from the DRGs. Moreover, the administrative database generated with these data is widely used in research and epidemiology, among other purposes. Objective: To explore the perceptions of medical coders (medical doctors) regarding possible problems with health records that may affect the quality of coded data. Method: A qualitative design using four focus groups sessions with 10 medical coders was undertaken between October and November 2017. The convenience sample was obtained from four public hospitals in Portugal. Questions related to problems with the coding process were developed from the literature and authors’ expertise. The focus groups sessions were taped, transcribed and analysed to elicit themes. Results: There are several problems, identified by the focus groups, in health records that influence the coded data: the lack of or unclear documented information; the variability in diagnosis description; “copy & paste”; and the lack of solutions to solve these problems. Conclusion and implications: The use of standards in health records, audits and physician awareness could increase the quality of health records, contributing to improvements in the quality of coded data, and in the fulfilment of its purposes (e.g. more accurate payments and more reliable research).

Despite being a potential cause of morbidity and economic costs, adverse events remain insufficiently studied. Therefore, we aimed to assess the frequency and impact of adverse events among inpatients. We analysed an administrative database containing a registration of all hospitalisations occurring in Portuguese public hospitals between 2000 and 2015. We identified all episodes with a registration of adverse events, and classified them into three categories, namely (1) misadventures of surgical and medical care, (2) complications of surgical or medical procedures, and (3) adverse drug events (including adverse drug reactions, poisoning events, and late effects). These episodes were compared over their length of stay, in-hospital mortality, and hospital costs with an equal number of hospitalisations matched for patients’ and episodes’ characteristics. Between 2000 and 2015, 5.8% (n = 861,372) of all Portuguese hospitalisations had a registration of at least one adverse event. Hospitalisations with registration of adverse events had a median length of stay of 8 days, median hospitalisation costs of 3060.7 Euro, and an in-hospital mortality of 6.7%. Hospitalisations with registration of misadventures of care, complications of procedures and adverse drug reactions had significantly higher lengths of stay and hospitalisation costs than their matched controls. In-hospital mortality was significantly higher for episodes of misadventures of care and complications of procedures, but lower for adverse drug events hospitalisations. Therefore, adverse events are common among inpatients, and have an important clinical and economic impact. Administrative databases may be useful in their epidemiological assessment.